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, • <br /> NEW SECURITY-INTEREST HOLDERS • - • • • <br /> Security-interest holder name: <br /> • <br /> -0 Mailing address: <br /> f1.2 <br /> Security-interest holder name: <br /> • <br /> Ft' • <br /> a Mailing address: <br /> ce) <br /> Buyer/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 <br /> sale/change of ownership. <br /> I understand that the home cannot be relocated without first completing this form and purchasing a trip permit from the <br /> State of Oregon,Building Codes Division or one of its county agents. <br /> • <br /> I understand that the seller/owner is responsible for submitting this Ownership Document Application to the State of <br /> Oregon,Building Codes Division or one of its county agents within 30 days after closing of the sale,and that all <br /> • — buyers and sellers will be notified•by mail when the application is completed. I understand that,should the seller/owner <br /> fail to file this Ownership Document Application within 30 days,I may complete the filing [ORS 446.641(I)]. 1 further <br /> 4 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): 0 Right of survivorship Buyer/new owner signature: Date: <br /> Robert <br /> Lvit 1) <br /> e Cr 19 <br /> ti Buyer/new owner name(print): Right of survivorship Buyer/new owner signature: Date: <br /> Buyer/new owner name(print): 0 Right of survivorship Buyer/new owner signature: Date: <br /> 1.) <br /> Buyer/new owner name(print): 0 Right of survivorship Buyer/new owner signature: Date: <br /> Seller/current owner acknowledgement of sale/change of ownership <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.All current owners,including security-interest holders,must acknowledge the sale/change of <br /> ownership by signing the ownership document or DMV title or completing the section below. Security-interest holders <br /> may elect to acknowledge the sale/change of ownership,but maintain their security interest until such time as they no <br /> longer have an interest in the home. <br /> Seller/current owner affidavit I affirm that I am the current owner of this structure and acknowledge that the seller is <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)1 <br /> 440-2952(7/17/C010) Page 4 <br />