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, <br /> cam.. <br /> SE b NEW OWNER ACKNOWLEDGEMENT(One name per box) <br /> 0 Person El—Business ❑Trust ❑Guardian <br /> re- Legal Name: /� Phone:CC „_(last,Rrst,middle) //�.zT--&r -4,7e7e /itl.; S 03. S i <br /> ' <br /> ZUJ Mailing Address: f <br /> 3-7 s' f` s f V <br /> O city: r� State: U� ZIP: 9-z / <br /> (il.)OD 0 igtL en <br /> Email: <br /> W Right of <br /> Survivorship ❑Yes 2 No <br /> Signature: ) Date: <br /> ❑Perso' 0 Business 0 Trust_- ` El Guardian <br /> IN Legal Name: Phone: <br /> cc (lasts nniddte) <br /> Z Mailing ---- -- <br /> Address: <br /> O City: ,.•'' - State: ZIP: <br /> Email: /' f <br /> W Right or �❑ <br /> Z Survivorship:D Yes No <br /> Si g"/ <br /> gna ture: Date: <br /> El Person ❑Business ❑Trust ❑Guardian <br /> M,. Leg <br /> i'-�al Name: <br /> CC (last,first,middle) ' <br /> f' Phone: <br /> Z Mailing Address: <br /> OCity: State: ZIP: <br /> Email: - -- <br /> WRight of Q Yes No <br /> Z Survivorship <br /> Sigrid-litre: Date: <br /> i <br /> ❑Person El Business El Trust ❑Guardian <br /> d, Legal Name: <br /> (last,first,middle) Phone: <br /> r <br /> 6Y Mailing Address: ®� <br /> Z 1 <br /> City: �-! _ State: ZIP: <br /> O <br /> Email: <br /> WRight g ❑ <br /> jYes ❑No <br /> Z Survi rs tp. <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 change <br /> of ownership.I understand that the home cannot be relocated without first completing this application and purchasing a trip permit <br /> 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;I <br /> 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 /> Page 3 <br />