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. . . . . . I . SECTION 6 . NEW OWNER ACKNOWLEDGEMENT (One name per box) • . . X I Person Business U Trust Guardian Legal Name:Anderson, Dena, Phone: - • ' - • C4 •(last,first,middle) tu 101- 1o12- tl g 0 z Mailing Address:9874 Golf Club Rd #9 City:Stayton State:OR ZIP:97383 0 Email:Denaca85@gmail.com . . ' Right of Yes 7 No . ILI Z Survivorship: ,.; Signatur . Date: (_..41WeA ___.--- Person ' 7 Business 7 Trust 7. Guardian 'Cs] Legal Name:„ Phone:. . . . . ce (last first,middle) Ill . Z Mailing Address: City: State: ZIP: • 0 Email: . - Right of Yes 7 No ' • •. • .• _ • Z Survivorship: • _ . Signature: Date: . . . , • . 1 Person r7 Business 7 Trust Guardian • re) Legal Name:, , Phone: C4 (last,first,middle) • •Z • Mailing Address: , , • , • City: . . State: ZIP: Email: . LLI Right of 7 Yes No • •z ' Survivorship: • Signature: . Date: FI Person Business Trust ri Guardian , vr Legal Name:, Phone: Ce - (last,first,middle) Ill Z Mailing Address: City: _ State: ZIP: 0 Email: Right of 1:1 Yes I 1 No . Z Survivorship: • Signature: Date: - I . , NEW OWNER ACKNOWLEDGEMENT OF SALE/CHANGE OF OWNERSHIP I affirm that the information provided herein accurately reflects the ownership of the structure at completion of the sale or , change of ownership. I understand that the home cannot be relocated without first completing this application and purchasing a trip,permit from the Building Codes Division or through one of its county agents. . I understand that the seller/owner is responsible for submitting this application within 30 days after the close of the sale, and • . . 1 that all buyers and sellers will be notified by mail when the application is approved. If the application has not been submitted , after 30 days,I may complete the filing under ORS 446.64(1). • I understand that each lessor, mortgagee,trust-deed beneficiary, lien holder of record,and security interest holder must be listed on this notice. If none are listed,the structure must be free and dear of all mortgages,deeds of trust,security interests, and liens. , , • • . . Page 3 . _ , ..._. ' • . i . _ .