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1617150 <br /> SECTION 6 , . <br /> NEW OWNER ACKNOWLEDGEM(tPIT(One name a per box) <br /> Person Business <br /> n Trust (-Guardian <br /> IX Legal Name: Silbernageustin <br /> 15 <br /> W past,first,middle) i A I Phone: 5D3 .-,1' avC� <br /> Mailing Address: )LZoLI 'LI 00 bi Q '• <br /> , Pa: ` e- <br /> City: , ' <br /> Q. . State: O1 I° ZIP: 973g3 <br /> Email: A�51-,rt 11 Sib rict P,10 nya.,'I.�m <br /> W • Right of IT Yes [—No <br /> z Survivorship: <br /> 1 Signature: W.-77,1A, <br /> I Date: lilaQ 95 <br /> N Person usiness Trust ! <br /> Guardian <br /> fX- Legal Name: <br /> Belcher Jayme <br /> I91 (last,first,middle) 1$ i Phone: �''i t 75,_ <br /> Liz_Z Mailing Address: (6 4 Oki 1A-i.hvo.4,,q, I g <br /> O. City: 1�m 1 State: C) ZIP: '7383 <br /> Email: <br /> b Qr-cX 1ndrTy� ,,,,,A, l . cry, <br /> Right of I— <br /> ,;,z, Survivorship: YesNo <br /> Signature: J L//..c 175 <br /> Date: r <br /> Person <br /> nth E E Business E Trust E Guardian <br /> E` Legal Name: <br /> la (last,first,middle) Phone: <br /> 2 Mailing Address: <br /> City: I State: I ZIP: <br /> Email: <br /> Right of <br /> z ,Survivorship: Yes No <br /> Signature: <br /> I Date: <br /> E Person [Business Trust E Guardian <br /> IY Legal Name: <br /> W (kst,first,middle) Phone: <br /> '2 Mailing Address: <br /> O City: I State: I ZIP: <br /> Email: <br /> W Right of r Yes No <br /> z Survivorship: r <br /> Signature: <br /> Date: <br /> NEW OWNER ACKNOWLEDGEMENT OF SALE/CHANGE OF OWNERSHIP <br /> I affirm that the information provided herein accurately reflects the ownership of the structure at the completion of the sale or <br /> change of ownership.I-understand that the home cannot be relocated without first completing this application and purchasing a trip <br /> permit from the Building Codes Division or through one of its county agents. <br /> I understand that the seller/owner is responsible for submitting this application within 30 days after the close of the sale,and that all <br /> buyers and sellers will be notified by mail when the application is approved.If the application has not been submitted after 30 days, <br /> I may complete the filing under ORS 446.64(1). <br /> I understand that each lessor,mortgagee,trust-deed beneficiary,lien holder of record,and security interest holder must be listed on <br /> this notice.If none are listed,the structure must be free and clear of all mortgages,deeds of trust,security interests,and liens. <br /> 440-2952(l 1/22/BCD) Page 3 <br /> OR Title Application-9/2024-TitleApp11211 <br /> 005013445-00003 <br />