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607418
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Last modified
9/21/2023 8:14:17 AM
Creation date
8/11/2023 11:26:31 AM
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Template:
Assessor
Account Number
607418
Assessor Doc Type
Trip Permit
Doc Type Date
8/9/2023
MTL
092E25D000800
Assessor Section
Manufactured Structures
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SECTION 6 NEW OWNER ACKNOWLEDGEMENT(One name per box); . <br /> 'rson ❑Business ❑Trust ❑Guardian <br /> Legal Name: Phone: <br /> (last:first, middle) C �. f ,. Al--ec>(e r i'O///f o. c ? � rJ�`!C) <br /> w, Mailing Address: 7 5-0c ti.. Sa i't,ta'rti - �! <br /> City: fv'1 jf C.,, fy State:© 4- ZIP: CT 5 6 <br /> Email: _ .. <br /> — <br /> W -.. . .Right of- ij Yes ❑No <br /> • g Survivorship: - <br /> Signature: j.._. Date: <br /> ______.gej <br /> 4 Person ❑ Business ❑Trust ❑Guardian <br /> Legal Name: ill Phone: .3,..9cb- Z.?,6 9 <br /> . ,middle) (r©���' <br /> (la first . /r1a�f► �� <br /> LnI Mailing Address: !07-,Z 0etA',rcr44' nye- <br /> Z <br /> ®' City: f,(.G,'2i. <br /> ,c, State: R ZIP: I. 30�.. <br /> Email: [,p <br /> h/ {�oy C9Yhir,/r (.a <br /> u1i. Right of <br /> Survivorship: <br /> Signature: %T� ‘,.. „ L,,,,---k./ Date: 5—, a023 <br /> 2/Person ❑Business ❑Trust ❑Guardian <br /> :' Legal Narne; Phone: <br /> (last;first..,n ddlel <br /> CCH <br /> '1! Mailing:;Address; • <br /> 3 City: State: ZIP: <br /> Email: <br /> •„Li1:' Right of , <br /> Z' Survivorship: <br /> - Signature: 'Date: .. • <br /> . . ❑Person ❑ Business ❑Trust ❑Guardian <br /> (V Legal Name: Phone: <br /> c;, (last,first,middle) . <br /> LU— Mailing Address: <br /> City: State: ZIP: <br /> 3' Email: <br /> LLI • Right of <br /> Z Survivorship: <br /> Signature: Date: . . <br /> NEW OWNER ACKNOWLEDGEMENT OF SALE/CHANGE OF OWNERSHIP . <br /> I affirm 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 /> application within 30 days after the close of the sale,and that all <br /> �� responsible for this� li <br /> • seller/o finer is submitting <br /> I understand that the > <br /> • PP <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 /> I 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 /> • <br /> • <br /> Page 3 . _ . <br />
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