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'`g.':s�'�L+.,r.2',tq't�'�i..f*`r.'`.i�",�,{ b��'�jrxt�'j�� m rlmLhSi S`;•+1''k13 s"��,^ 4wa ^}.:�r� Y .Y:f7�'y ."�vlb ^c�, C^ +rt2^. - x a iz ,.,,_ ,,,, - rt`r s^a 7 : �Y�]� , I � � �,J(��.t(�(�41,4 3 ` `r'-t,`yr,� i, 1y"b j f `t-2iJ a"•f:}n EY Y E OV�ly�T IiN ERE$P A 1 .. DG w,.' ".,,,'s,.s i*'9'�.*''.�',.d�.�i� �'..?..•re`„:.� �..� a�,�.�r��.n�rt.�3'+�rv�as:r:?~�v.�`�5 : Security-interest holder name: Mailing address: C/) Security-interest holder name: 4 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. '. I understand that the home cannot be relocated without first completing thisformand purchasing a trip permit from the ti State of Oregon,Building Codes Division,.or one of its county agents. `o 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 �. fail to:file this Ownership D'ocumentApplication within 30 days,I may complete.the filing[ORS 446,6411 )]: I further understand.that each lessor, mortgagee,trust-deed beneficiary, lien holder of record, and•security-interest holder must belisted on thisnotice, or, if none are listed,the manufactured structure must be free and clear of all mortgages,deeds of mist,security interests,and liens. Buyer/new owner name(print): ❑ Right of survivorship Buyer/new owner signature: Date: n u ave_rifle co-4 0l0;ne: i e23- za cr. Buyer/new owner name(print):(P ' ❑ Right of survivorship Buyer/new owner signature: Date: artizzer- Buyer/new owner name(print): ❑Right of survivorship Buyer/new owner signature: Date: 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/changeof 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 liome.. Seiler/current owner affidavit I affirm that I am the current owner of this structure and acknowledge thatthe seller is responsible for submitting notice of sale/change of ownership to the State of Oregon Building Codes Divisionor one,of its county agents within 30 days of the closing of the sale[ORS 446.641(1)]. 440-2952(71ii/COM) Page 4