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608388
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Last modified
9/14/2023 7:57:03 AM
Creation date
9/14/2023 7:57:02 AM
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Assessor
Account Number
608388
Assessor Doc Type
Trip Permit
Doc Type Date
9/13/2023
MTL
092E17BC01600
Assessor Section
Manufactured Structures
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SECTION 6 NEW OWNER ACKNOWLEDGEMENT(One name per box) <br /> 0 Person ❑Business ❑Trust ❑Guardian <br /> r, Legal Name:Torres, Richard Phone:503-302-1839 <br /> cc (last,first,middle) <br /> 2 Mailing Address:22988 North Fork Rd SE <br /> City:Lyons State:OR ZIP:97358 _. <br /> Email:blackcopal@gmail.com <br /> W-• Right of 0 Yes El No <br /> Z Survivorship: <br /> Signature: Date: - <br /> ❑■ Person ❑Business 0 Trust ❑Guardian <br /> r`i Legal Name:Torres, Megan Phone:503-302-1839 <br /> cc (last,first,middle) g <br /> z Mailing Address:22988 North Fork Rd SE <br /> 0 <br /> City:Lyons State:OR ' ZIP:97358 <br /> Email: _ <br /> W Right of E Yes El No t„. - <br /> Z . Survivorship: . , <br /> Signature: - Date: <br /> 0 Person ❑Business ,❑Trust ❑Guardian <br /> M Legal Name: <br /> cc (last,first,middle) Phone: <br /> Z Mailing Address: <br /> City: State: ZIP: <br /> 0 <br /> Email: <br /> WRight of ❑Yes ❑No <br /> Z Survivorship: <br /> Signature: Date: <br /> ❑Person El Business ❑Trust El Guardian <br /> d. Legal Name: <br /> cc (last,first,middle) Phone: <br /> 2 Mailing Address: <br /> City: State: ZIP: <br /> 0 <br /> Email: <br /> W Right of <br /> Z 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 />
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