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• NEW SEC•• • .TY.-INT. HOLDERS Security-interest holder name: Ts Mailing address: 42 6I i Security-interest holder name: ti Mailing address: � I u . u � 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 completibn of the .o sale/change of ownership. • • I understand that the home cannot be relocated without first completing this form and purchasing a trip permit from the i; State of Oregon,Building Codes Division or one of its county agents. I understand that the seller/owner is responsible for submitting this Ownership Document Application to the State of 3 Oregon,Building Codes Division or one of its county agents within 30 days after closing of the sale,and that all c .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 Document Application within 30 days, I may complete the filing[ORS 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(print): El Right of survivorship Buyer/ ew owner signature: Date: . Ronald Schmitt % i 12/8/2021 Buyer/new owner name(print): 1J Right of survivorship ,uyer/new owner signature: Date: 'o Kathryn Schmitt t X2/8/2021 Buyer/new owner name(print): ❑Right of survivorship Buyer/new owner signature: Date: as i 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/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 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 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/L7/COM) Page 4