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NEW SECURITY-INTEREST HOLDERS <br /> ›, Security-interest holder name: <br /> a, <br /> nz Mailing address: <br /> G <br /> Security-interest holder name: <br /> • Mailing address: <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 /> ti I understand that the home cannot be relocated without first completing this form and purchasing a trip permit from the <br /> 1,5 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 /> 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(1)]. I further <br /> • 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/i .. owner signature: Date: <br /> ayo- ciffife_ 9 <br /> Buyer/new owner name(print): ❑ Right of survivorship Buyer/new owner signature: Date: <br /> 0 <br /> • Buyer/new owner name(print): ❑Right of survivorship Buyer/new owner signature: Date: <br /> Pq <br /> Buyer/new owner name(print): ❑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 <br /> I affirm that I am the current owner of this structure and acknowledge that the seller is responsible for submitting notice <br /> of sale/change of ownership to the State of Oregon Building Codes Division or one of its county agents within 30 days of <br /> the closing of the sale[ORS 446.641(1)]. <br /> 440-2952(7/19/COM) Page 4 <br />