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<br /> ECTION6HI'' ' :"'' . ' .' 'NEW OWNER ACKNOWLEDGEMENT:(0ne name'per box) . .
<br /> Person 1 0 Business 0 Trust El Guardian
<br /> , . Legal'Name:( r,
<br /> ulsford, Janette Phone: 971-340-7108 -
<br /> l ast,first, middle) r
<br /> Ca .
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<br /> Mdiling-Address: 1 cicrt ..)01/4.rictrk WO-LI
<br /> City: L000 ci bULAe-t-\ I State: De_ I ZIP: 9-70-7 I
<br /> o,
<br /> cs - Email: Lkrif{i p ca V\0A•mck),..\ i 0...Da\ ''
<br /> Right of'
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<br /> '•..tZ.•• Survivorship: J2:fres It No '
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<br /> Signature: - ----oy -11144----------- Date: '(5/9,2d24,23
<br /> Person ;0 Business p Trust Ej Guardian ,
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<br /> Legal Name: Pulsford, Gerald Phone:91110-.3‘40 1/0E;
<br /> :.:'ce Oast,first,middle) .
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<br /> •. Mailing Address:
<br /> .. ,a . , City: 3 bo„,,r1 State: 0(2._ ZIP: 707,1 — •
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<br /> - Email: ckr\kilip
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<br /> ..., Right of 1--A....
<br /> en Yes No • - •• . Survivorship: •
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<br /> Signature: • gork-Ef,„. f.' 7(1 P`) r Date:la 6(11;200_3-
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<br /> 0 Person 0 Business Ej Trust 0 Guardian• .
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<br /> rIfl• Legal Name:
<br /> Phone: •
<br />, . ,tt•. (last,first,middle) .
<br /> LLI•
<br /> ' . Mailing Address:
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<br /> City: i I State: I ZIP: .
<br /> . 0-
<br /> Email:
<br /> Right of. I—,
<br /> Yes 0 No
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<br /> • ' Survivo Lirship: . . .
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<br /> Signature:
<br /> Date: • '. - . . . • •• • -:, - 0 Person 0 Business Ej Trust 0 Guardian • , • .
<br /> Legal Name:-
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<br /> - - - aast,lust,middle)
<br /> . CC' .
<br /> Phone:
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<br /> la ''Mailing Address: ,
<br /> ' . City: ,
<br /> State: 1 ZIP: •
<br /> -0
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<br /> . • Email:
<br /> -.1a Right of :
<br /> ''• Z'• Survivorship: /-1 I---iYes 0 No
<br /> Signature: ,
<br /> •Date: . .
<br /> NEW OWNER ACKNOWLEDGEMENT OF SALE/CHANGE OF OWNERSHIP . . ..
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<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
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<br /> from the Building Codes Division or through one of its county agents.
<br /> I understand that-the seller/owner is responsible forisubmitting this application within 30 days after the close of the sale, and that all •buyers and sellers will be notified by mail when til application is approved. If the application has not been subthitted after 30 days, I , • ;may complete the filing under ORS 446.64(1), i
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<br /> lunderstand that each lessor,mortgagee,trust-deed-beneficiaty, lien holder of record,and security interest holder must be listed oh this notice. If none are listed,the structure must be free and clear of all mortgages,deeds of trust,security interests,and liens,
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