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<br /> NEW SECURITY NTEREST HOLDERS ,
<br /> Security-interest holder name:
<br /> 21st Mortgage j
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<br /> -0 Mailing address:
<br /> t 620 Market St, Suite 100
<br /> e Knoxville, TN 37902
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<br /> Security-interest holder name: i I
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<br /> ,a Mailing address: 11
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<br /> Buyer/new owner acknowledgement of sale/change of ownership I
<br /> I affirm that the information provided herein accurately reflects the ownership of the structure at the completion ofltlte
<br /> sale/change of ownership.
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<br /> I understand that the home cannot be relocated without first completing this form and purchasing a trip permit from.'idle
<br /> ',, State of Oregon,Building Codes Division or one of its county agents. Il
<br /> 1 c I understand that the seller/owner is responsible for submitting this Ownership Document Application to the State if
<br /> Oregon,Building Codes Division or one of its county agents within 30 days after closing of the sale,and that all i
<br /> buyers and sellers will be notified by mail when the application is completed. I understand that,should the seller/o�ner
<br /> fail to file this Ownership Document Application within 30 days, I may complete the filing [ORS 446.641(1)].I fu}fher
<br /> ot understand that each lessor,mortgagee,trust-deed beneficiary, lien holder of record, and security-interest holder must
<br /> be listed on this notice,or,if none are listed,the manufactured structure must be free and clear of all mortgages,deeds
<br /> of trust,security interests, and liens.
<br /> Buyer/new owner name(print): ❑Right of survivorship Buyer/n a 'ner signature: _Date: I
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<br /> aLi Buyer/new owner name(print): ❑Right of survivorship Buys Vries owner signature: Date: i"
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<br /> Buyer/newlowner`name(print): ❑Right of survivorship utter/ w ot{'ter signature: Date:
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<br /> CA
<br /> Buyer/new owner name(print): El Right of survivorship Buyer/new owner signature: Date: j
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<br /> . Seller/current owner acknowledgement of sale/change of ownership j
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<br /> Application must be accompanied by the appropriate valid County Manufactured Home Notification form,
<br /> All owners must release their interest or acknowledge this sale/change of ownership in the structure in order to
<br /> complete this application.AU current owners,including security-interest holders,must acknowledge the sale/chang Iof
<br /> ownership by signing the ownership document or DMV title or completing the section below. Security-interest holder's;
<br /> may elect to acknowledge the sale/change-of ownership,but maintain their security interest until such-time as they no i .
<br /> longer have an interest in the home.. I I
<br /> Seller/current owner affidavit I affirm that I am the current owner of this structure and acknowledge that the seller iii
<br /> responsible for submitting notice of sale/change of ownership to the State of Oregon Building Codes Division or one of
<br /> its county agents within 30 days of the closing of the sale [ORS 446.641(1)]. ,l
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<br /> 440-2952(vi;?COm) Page 4 1
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