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• CxURI� -lEsr 131 } FtS r t Security-interest bolder name: MaimTrigaddress: u rf2 d Security-Interest bolder name: Mailing address: •d I Boyer/new owner acknowledgement of sale/change of ownership I affirm That the informationprovided herein accurately reflects the ownership of the structure at the completion of the 77, sale/change ofownership. I understand that the home cannot be relocated without first completing this form and purchasing a trip permit from the State of Oregon,Building Codes Division or one of its county agents. 9 I understand that the sellerlowner is responsible fur submitting this Ownership Document Application to the State of g Oregon,Building Codes Division or one of its county agents within 30 days after closing of the sale,and that all E buyers and sel leis will be notified by mail when the application is completed I understand that,shoidd the miler/owner fail to file this Ownership Doemnent:AppIication within 30 days,I may complete the filing[ORS 446.541(1)].I further understand that each lessor,,mortgagee,trust-deed beneficiary,lien holder of record,and security-interest holder must be listed on this notice,or,if none are listed,the manufactured structure must be free and clear of all mortgages,deeds Of trust,security interests;and liens. Buyer/new owner name(pr/ni): ®Right of survivorship erhnew owner signature: Date: l Buycr/newowner name(print): E Rightofstuvivorship Buye'r/newowner signalure: Date: g Buyer/new owner mune(pri o; 'gun ofsurvi ars3iip Buyer/new orrnersigmture: Date:. Pa Buyer/new owner name(pr7I): flRight ofsurviwrsbip Buyer/new PimerApra him Date: Seller/current owner acknowledgement of sale/change of ownership Application must he accompanied by the appropriate valid County Manufactured Borne Notification form. All owners must release their interest or acknowledge this salelchnngc of ownership in the struteture murder 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,hut maintain their security interest until such time as they no longer have an interest in the home. Sellerlcurrent owner affidavit I affirm that I am the current owner of this structure and acknowledge that the seller is responsible for submitting notice ofsalelchange of ownership to the State of Oregon Building Codes Division or one of Its county agents within 36 days of the closing of the sale[ORS 446.641(1)]. 440.2952(71111COst) Page 4