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Docusign Envelope ID:C085CA2C-A04E-4E4D-9131-373F9C76E16B <br /> 1824182 <br /> SECTION 6 NEW OWNER ACKNOWLEDGEMENT(One name par boa) <br /> ,t— y Person [Business Ei Trust • ❑Guardian <br /> ir Legal Name: Gonzalez John f _ <br /> UJ (last first,WNW I Phone:(3 j ( 6 —11 fl1 <br /> Mares Ads- - Li f t '��°Pi .�,1 —' 3 l� 1 <br /> iiiill , i a � i C State: t1(...4_-. _I zlP: 6i 71 <br /> Email: t 0 1 a i 041.I. �. <br /> g - Right of r ea [No <br /> z Survivorship: <br /> 1 <br /> Signature: r_ W_____ Date: <br /> IN <br /> 1 'Person [Business [1 Trust El Guardian <br /> Legal Name: Gonzalez Jamie <br /> LU' flagfru,mldde) Phone: <br /> ZMailing Address: ;S�t. ,.) f) (1141 I2d ki <br /> o <br /> QtY: !-. Lit_.. I state:0 I. I ZIP: G 717 <br /> Right of N., <br /> Ili <br /> Survivorship: Yes p No <br /> Signature: ,f`r -.c ivy I Date:- -..,2 <br /> M. 0 Person E Business D Trust D Guardian <br /> ae Legal Name: <br /> LU (lam,first,middle) I Phone: <br /> Z Mailing Address: <br /> City: I State: 1 UP: <br /> Email: <br /> vRight op: [Yes [No <br /> z rshi <br /> Si I Date: <br /> v. <br /> []Person C Business [Trust [Guardian <br /> gE Legal Name: <br /> UJ. //art fust rnwd<e) Phone: <br /> Z Mailing Address: <br /> 0 City: I_State: I ZIP: <br /> Email: <br /> LU Right of [Yes [No <br /> z Survivorship: <br /> Signature: 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 /> • <br /> 440-2952(11/22/BCD) = Page 3 <br /> Ok Tate Application-9/2024-TaleApp11211 005056382 00005 <br />