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NEW SECURITY-INTEREST HOLDERS t, Security-interest holder name: nnU Mailing address: d Security-interest holder name: cis Mailing address: 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. 1,04t1 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. c I understand that the seller/owner is responsible for submitting this Ownership Document Application to the State of d Oregon, Building Codes Division or one of its county agents within 30 days after closing of the sale,and that all a buyers and sellers will be notified by mail when the application is cot r leted.I understand that,should the seller/owner a fail to file this Ownership Document Application within 30 days, m complete the filing[ORS 446.641(1)]. I further 0 understand that each lessor,mortgagee,trust-deed beneficiary, he er of record,and security-interest holder must be listed on this notice, or, if none are listed,the manufact wed ' , to • mist be free and clear of all mortgages,deeds of trust,security interests,and liens. Buyer/new owner name(print): D Right of survivorship uy v • er signature:': Date: 44-4-7-QE M 0114 aBuyer/new owner name(print): ❑Right of survivorship Buyer/n": • nersignatuie: Date: SA /'61 ? Buyer/new owner name(print): ❑Right of survivorship Buyer/new owner signature: Date: Oa 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 l 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 days of the closing of the sale[ORS 446.641(1)]. 440.2952(7,1 TON) Page 4