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YttM N iB x „ i Nemi. *NER-ACIfMOWi tidEMENT(6ne,nat>:Oer bitk ° <br /> r „7 0 Person ®Business ❑Trust ❑Guardian <br /> ?N1 <br /> ,,, i Legal.Name:CPI SUNDIAL OWNERS LLC Phone:503-244-2300 <br /> -" (last,first,middle) <br /> Mailing Address:18150 SW BOONES FERRY ROAD <br /> Nc.":,, <br /> City:PORTLAND State:OR ZIP:97224 <br /> ?��'` 1 Email: <br /> f 4e .. <br /> .Right of . <br /> 'Z4° Survivorship: ❑Yes ❑No <br /> :: Signature: (2 <br /> •Date: -'�,_. <br /> ` ❑Person ❑Business ❑Trust ❑Guardian <br /> Pl...:`,::' Legal Name: <br /> , (last,first, middle) Phone: <br /> t. , <br /> Mailing Address: <br /> City: State: ZIP: <br /> �� �,. Email: <br /> t-. <br /> ?� Right of ❑Yes El No <br /> y -Ato Survivorship: <br /> Signature: <br /> -4f Date: <br /> El Person ❑Business ❑Trust <br /> 4Y,,„ Guardian <br /> d Legal Name: <br /> (last,first,middle) Phone: <br /> �if Mailing Address: <br /> kg'33 <br /> a . . <br /> { <br /> City: State: ZIP: <br /> ,' Email: <br /> ,' <br /> AW'" Right of ri❑Yes ❑No <br /> ,' Survivorship: <br /> ,3•: Signature:- Date:' . - <br /> ❑Person ❑Business ❑Trust ❑Guardian <br /> -nkx. <br /> 4.; Legal Name: <br /> Phone: <br /> ��.; (last,first,middle) <br /> - Mailing Address: <br /> fk; "' City: State: ZIP: <br /> 4 <br /> 'i 'i <br /> w* Email: <br /> w, <br /> Right of <br /> '1' ❑ ❑i Survivorship: Yes No <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 />