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3: �.�<.r.•. rt`- lG,e� , r„'�I°'�<.:•:•...y ,..�-^r'. .j .a , •. .^'�':7-)?-^^— .13r,,,.4.,•,7—.,. y.i. -, '` <br /> aw l ' i .,q �'g r�� hlt�Iam 1 , k ry, Ilj ,GC' N'T../i`;` "riq' gyp., ;. i ;,='.a <br /> -a.-t tP ,..,,. ...5�..(.,Li.;.. ....,.r �n , - �•a;,s.,.• t ! .. tii. ,. c..fa�t^ ,r ik;•,;,; ;^� <br /> !`Ltt <br /> pn�,�,, , ❑Person ®'Business D Trust •❑Guardian <br /> ,").Ls Legal <br /> x me 140,0 CO 0 r ` I R Ck,/ V Eat Phone: i ': (/e(at,first, <br /> _I Mailing Address: S7 HZ) Lid` .� I ' f q (-1(2 { . • <br /> G� <br /> • <br /> i•_,`-; City ) 'tr`�r� State: Zrn: ��' <br /> 4,4 <br /> Email: \,<,.. 9fl 1�. �C V (��a�� d 1'a awl <br /> i;.str, <br /> i Right of t� <br /> ts ' Survivorship: ❑Yes [2 No <br /> }}µµme YfbYk, Signature: - Date;- <br /> OM <br /> ly,'r,tail; ❑Person ❑ Business ❑Trust 0-Guardian <br /> 5y:'.iA <br /> . ;f� Legal Name: . <br /> •W? Phone: <br /> nc; . (last,first,middle) • ' <br /> Mailing Address: <br /> - City: State: ZIP: <br /> 11.ti,i <br /> b-x <br /> Email: . .rreF �.: Right of ❑Yes ❑No • <br /> '.,t( j' • .Survivorship: <br /> 14,1 a Signature: - Date: . <br /> sexyA - <br /> ' '. ❑Person ❑ Business ❑Trust ❑•Gtli-irdian <br /> �` Legal Name: <br /> F;4., x, Phone: <br /> (:w- 1; (last,first, middle) <br /> M:,,•;,Rr4.1§!:2.eii, ,..:•a <br /> ailing Address: <br /> ; ; ,,f°ii w, • City: State: ZIP: . <br /> ::, �, Email: • <br /> r Right of Yes No <br /> 55�1°�;:s Survivorship: <br /> ❑ ❑ • . . <br /> • 1 -4 Signature: • Date: <br /> • <br /> *z7Y.4 - Person <br /> yy,, ., ❑ ❑Business ❑Trust ❑Guardian' <br /> a ' `X` Legal Name: Phone: <br /> i.,, • <br /> at _ <br /> v (last,first;middle) <br /> 1 Mailing Address; <br /> i' City: State: • ZIP: <br /> VOtv{ Email: • <br /> '3 tt Right of <br /> `^-•t IV Survivorship:krer ❑Yes ❑No <br /> � 4 'ar nr �j <br /> �s4-j;3;t. Signature: I Date: <br /> it t: '- 1-� • <br /> NEW OWNER ACKNOWLEDGEMENT OF SALE/CHANGE OF OWNERSHIP <br /> 1 afrtn that the information provided herein accurately reflects the ownership of the structure at the completion of the sale or change <br /> ..of ownership. I understand that the home cannot be relocated without first completing this application and purchasing a trip permit • <br /> 'from the Building Codes Division or through one of its county agents. <br /> I understand that the seller/owner is responsible for submitting this application within 30 days after the close of the sale,and that all • <br /> :buyers and sellers will be notified by mail when the application is approved, If the application has not been submitted after 30 days, I • <br /> .may complete the filing under ORS 446.64(1). • <br /> ,l understand that each lessor; mortgagee, trust-deed beneficiary, lien holder of record,and security interest holder must be listed on . <br /> ,this notice.If none are listed, the structure must be free and clear of all mortgages, deeds of trust, security interests,and liens, <br /> Page 3 <br />