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DocuSign Envelope ID:BC82F0C2-F6EE-4EC.. .,C38-F05F91E29D16 1447112 • ___ NEW SECURITY-INTEREST HOLDERS Security-interest holder name: 1. • Mailing address: . isI • a u 97 to ______ I Security-interest holder name: - ei.I Mailing address: �" m d V a • e Buyer/new owner acknowledgement of sale/change of ownership - tI affirm that the information provided herein accurately reflects the ownership of the structure at the completion of the sale/change of ownership. E I understand that the home cannot be relocated without first completing this form and purchasin a tripe i the State of Oregon,Building Codes Division or one of its county agents. g p rmlt from I understand that the seller/owner is responsible for submitting this Ownership Document Application to the State f f of Oregon,Building Codes Division or one of its county agents within 30 days after closing of the sale,and that all! i buyers and sellers will be notified by mail when the application is completed. I understand that, should the 1 1, seller/owner fail to file this Ownership Document Application within 30 days, I may complete the filing [ORS 0 446.641(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(prini) ygRight of survivorship er/ Buynew o ^— Robert Johnstone �$€sfsSW a - Date: 3 10/14/2021 --•___ ___ Ybl� rt ,�6 )-bbl1. Buyer/new owner name(print) 0 Right of survivorship Buyer/ne 6fiw iil16j. Date: I C Buyer/new owner name(prinl) Right of survivorship (Buyer/new owner signature: !Date: Buyer/new owner name(print) 0 Right of survivorship Bnyer/new owner signature: , ate: Date: Seller/current owner acknowledgement of sale/change of ownership I 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 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 1 they no longer have an interest in the home. Seller/current owner affidavit I affirm that I am the current owner of this structure and acknowledge that the seller is i 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(7/19/COM) OR Title Application-10/2019-TitleApp 11211 Page 4 • 004489498-00002