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613846 (2)
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613846 (2)
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Last modified
5/26/2026 11:03:50 PM
Creation date
5/26/2026 3:58:48 PM
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Assessor
Account Number
613846
Assessor Doc Type
Trip Permit
Secondary Assessor Doc Type
Jacket
Doc Type Date
5/4/2026
MTL
091W04C001500
Assessor Section
Manufactured Structures
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• <br /> Docusign Envelope ID:783C2C2B-0508-8AA5-800A-0A5CBE235DDA <br /> SECTION 6 ;�NEW OWNERACKNOWLEDGEMENT,(One name per boz) <br /> El Person ❑Business ❑Trust ❑Guardian <br /> Legal Name:Howton, Benjamin John Phone:503-702-6185 <br /> tr (last,first,middle) <br /> Mailing Address:9874 Golf Club Rd SE#26 <br /> 0 City:Stayton State;OR ZIP:97383 <br /> Email:howtonbl @yahoo.com <br /> W Right of ❑Yes M No <br /> z: Survivorsljjp-5 ,, by. <br /> Signateri 1)S1'—, Date: 5/4/2026 110:19 AW PDT <br /> `--EB83B713798A4EA_ <br /> 0 Person ❑Business ❑Trust ❑Guardian <br /> Legal Name: Phone: <br /> (last,first.middle) <br /> CC <br /> W Mailing Address: <br /> City: State: ZIP: <br /> Email: <br /> Right of Yes ❑No <br /> • Z. Survivorship: <br /> Signature: Date: <br /> ❑Person ❑Business ❑Trust ❑Guardian <br /> Legal Name: Phone: <br /> re (last,first,middle) <br /> ZMailing Address: <br /> City: State: ZIP: <br /> Email: <br /> W Right of <br /> Z Survivorship: Yes El No <br /> Signature: Date: <br /> ❑Person ❑Business ❑Trust ❑Guardian <br /> Legal Name: <br /> d' Phone: <br /> CC (last,first,middle) <br /> Z Mailing Address: <br /> s . City: State: ZIP: <br /> 0 <br /> Email: <br /> W- Right of ❑Yes 0 No <br /> 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 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 />
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