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• "s^ t NEW.SECURITY-lNTEREST�HOLDERS ,.A • ';"">. _; Security-interest holder name: c io u Mailing address: L • 0 C.) . a V) Security-interest holder name:" . ' :ca• Mailing address: d L CJ 6 Buyer/new owner acknowledgement.of sale/change of ownership I affirm that the information provided herein accurately reflects the ownership of the structure at the completion of the sale/change of ownership. • b • �. I.understand that the home cannot be relocated without first completing this form and purchasing a trip permit from the d State of Oregon,Building Codes Division or one of its county agents. . a •c• I understand that the seller/owner is responsible for submitting this Ownership Document Application to the State of - Oregon, Building Codes Division or one of its county agents within 30 days after closing of the sale,and that all • buyers and sellers will be notified by mail when the application is completed. I understand that,should the seller/owner • y• fail to file this Ownership Document Application within 30 days,I may complete the filing[ORS 446.641(1)].I further understand that each lessor, mortgagee,trust-deed beneficiary, lien holder of record, and security-interest holder must . be listed on this notice, or, if none are listed,the manufactured structure must be free and clear of all mortgages,deeds • of trust,security interests,and liens. •. Buyer/i ew owner na ne:�tprint): ❑Right of survivorship Buyer/new owner signature: Date: • m: Buyer/new owner lime(print): ❑ Right of survivorship •Biry-ertn ' o‘c -o sig ,}tiire: Da e: •c :3 - o _ Buyer/new owner name(print): ❑Right of survivorship Buyer/new owner signature: • Date: 14, .>i Buyer/new owner name(print): ❑ Right of survivorship Buyer/new owner signature: Date: • Seller/current owner acknowledgement of sale/change of ownership Application must be accompanied by the appropriate valid County Manufactured Home Notification form. All owners must release their interest or acknowledge this sale/change of-ownership in the structure in order to complete this application. All current owners, including security-interest holders,must acknowledge the-sale/change of ownership by signing the ownership document or DMV title or completing the section below.Security-interest holders may elect to acknowledge the sale/change of ownership, but maintain their security interest until such time as they no longer have an interest in the home. Seller/current owner affidavit I affirm that I am the current owner of this structure and acknowledge that the seller is • responsible for submitting notice of sale/change of ownership to the State of Oregon Building Codes Division or one of its county agents"within 30 clays pf the closing of the sale[ORS 446.641(1)]. 440-2952(7117/COM) • Page 4 •