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"" a= s,, <br /> , 1� tJ�iiTY� �F tPST HOLD R " ;R t*ri , <br /> Security-interest holder name: <br /> el <br /> 0 Mailing address: <br /> v <br /> Security-interest holder name: <br /> as <br /> • Mailing address: <br /> 6> <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 /> 4-4I understand that the home cannot be relocated without first completing this form and purchasing a trip permit from the <br /> d State of Oregon, Building Codes Division or one of its county agents. <br /> Ei 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 /> a buyers and sellers will be notified by mail when the application is completed. 1 understand that,should the seller/owner <br /> f• ail to file this Ownership Document Application within 30 days, I may complete the filing[ORS 446.641(1)]. i further <br /> O• 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): N Right of survivorship Buyer/new owner signature: Date: <br /> Buyer/new owner name(print): ❑ Right of survivorship Buyer/new owner signature: Date: <br /> 0 <br /> c Buyer/new owner name(print): 0 Right of survivorship Buyer/new owner signature: Date: <br /> 0 <br /> Ra <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)]. <br /> 440-2952(7/171COM) Page 4 <br />