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608331
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Last modified
9/6/2023 9:17:58 AM
Creation date
9/6/2023 9:17:57 AM
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Assessor
Account Number
608331
Assessor Doc Type
Trip Permit
Doc Type Date
8/30/2023
MTL
081W160000100
Assessor Section
Manufactured Structures
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SECTION 6 NEW OWNER ACKNOWLEDGEMENT(One name per box) <br /> ❑Person El Business ❑Trust ❑Guardian <br /> Legal Name: Doerfler Farms, Inc. Phone:503-887-6652 <br /> cc (last,first,middle) <br /> uu Mailing Address:12333 Silver Falls Hwy SE <br /> } City:Aumsville State:OR ZIP:97325 <br /> Email:amy@doerflerfarms.com <br /> WRight of ❑yes ❑■ No <br /> Survivorship: <br /> Signature: Date: <br /> ❑Person ❑Business El Trust ❑Guardian <br /> fV Legal Name: <br /> CC (last,first,middle) Phone: <br /> zMailing Address: <br /> City: State: ZIP: <br /> Email: <br /> W Right of ❑Yes ❑No ' <br /> Survivorship: <br /> Signature: Date: <br /> El Person El Business El Trust ❑Guardian <br /> Legal Name: Phone: <br /> Ie (last,first,middle) <br /> Z Mailing Address: <br /> City: State: ZIP: <br /> 0 <br /> Email: <br /> W Right of ❑Yes ❑No • <br /> -,Z Survivorship: <br /> • Signature: Date: <br /> El Person El Business El Trust ❑Guardian <br /> • d.. . Legal Name: <br /> CC • (last,first,middle) Phone: <br /> Z • Mailing Address: <br /> City: State: ZIP: <br /> 0 <br /> Email: <br /> W Right of ❑yes ❑No <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 /> 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 /> 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 /> Page 3 <br />
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