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1496272 NEW SECURITY-INTEREST HOLDERS Security-interest holder name: I- Mailing address: co Security-interest holder name: a Mailing address: d COI 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 completion of the sale/change of ownership. es 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. g I understand that the seller/owner is responsible for submitting this Ownership Document Application to the State 3 of Oregon,Building Codes Division or one of its county agents within 30 days after closing of the sale,and that all 6 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 g 446.641(1)]. I further understand that each lessor, mortgagee, trust-deed beneficiary, lien holder of record, and 14 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) n Right of survivorship Buyer/new owner signature: Date: Jered Moberg eBuyer/new owner name(print) 0 Right of survivorship Buyer/new owner signature: Date: Jessica Murphy 1 Buyer/new owner name(print) Right of survivorship Buyer/new owner signature: Date: 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(7/19/COM) OR Title Application-10/2019-TitleApp11211 Page 4 004664330-00004