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DocuSign Envelope ID:F770620C-DDA1-42B9-A1AA-33ABCF8C11AB <br /> NEW OWNER ACKNOWLEDGEMENT(One name per box).. <br /> SECTION':6'::::: ::�::::. : :::.: :: � >:'::: ❑Trust ❑Guardian . <br /> 0 Person ❑Business <br /> Legal Name:He1rns,�a— <br /> Nieholl Phone:971-218-0313 <br /> cc c■ .`. last, trst,middle <br /> Mailing Address:4089 Ward Dr. NE State:OR ZIP:97305 <br /> Email:nichol10130he1ms@gmall.com <br /> Right of <br /> W`::: • El Yes 0 No 1/23/2023 13: 5 PM <br /> Z Survivorshi.: Date: <br /> 0 Pers. DADC359702BA410... 0 Business <br /> ❑Trust 0 Guardian <br /> Phone: <br /> Legal Name: <br /> et ` last trst middle <br /> 1M Mailing Address: ZIP: <br /> ':Z° :. <br /> 0 <br /> of Right'aad::;. Ri g []Yes El No <br /> Z:: Survivorshi.: Date: <br /> []Person ❑Business <br /> El Trust ❑Guardian <br /> Phone: <br /> Legal Name: <br /> CX last, trst,middle <br /> la Mailing Address: ZIP: <br /> z:: comi <br /> • <br /> °.I :-. Right of ❑Yes ❑No <br /> Z. Survivorshi.: Date: <br /> ❑Trust ❑Guardian <br /> CI 0 Business <br /> Phone: <br /> 1,: Legal Name:et: _ <br /> last trst middle <br /> la.;. Mailing Address: ZIP: <br /> Z : <br /> Right of <br /> l� Yes ❑No <br /> Z`:: Survivorshi.: Date: <br /> .NEW OWNER ACKNOWLEDGEMENT OF SALE/CHANGE OF OWNERSHIP <br /> on of <br /> I affirm that the information provided herein accurately reflectsfirst completing thiship of the tappltcat on and 1pu�rchasing a trip permitchange,e sale or <br /> of ownership.I understand that the home cannot be relocated without agents. <br /> • from the Building Codes Division or through one of its county a g <br /> I understand that the seller/owner is responsible for submitting application ais aproication ved.If thelin application d has not been submittedys after-the close of the lafter 30 days,I <br /> buyers and sellers will be notified by mail when the apple PP <br /> may complete the filing under ORS 446.64(1). <br /> der <br /> e <br /> I und <br /> erstand that each lessor,mortgagee,trust-deed beneficiary,lien homortgages,of <br /> rcrd,de andds o trust, interest <br /> holder <br /> andb elisted on <br /> this notice.If none are listed,the structure must be free and clear of all <br /> Page 3 <br />