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r ,A.-- <br /> `—'-' - ittPArOyor 11!0", <br /> , . <br /> ... <br /> ' ' _---- <br /> / 7 <br /> 7/ <br /> ,.. • ..... <br /> tar <br /> a <br /> / 7 I <br /> 1 <br /> • cinanco.og G`''''''' <br /> ION 6 NEW OWNER ACKNOWLEDGEMENT(One name per box) <br /> . .,„. <br /> El <br /> .. EIPerson 0 Business El Trust Guardian <br /> ,.., <br /> / A 0.... .. C Phone:5,a3-wi/e23,/ <br /> - (lase.first.middle) k_ _) d r"--e )177-hr nxe c__ <br /> cc <br /> Mailing Address: ) An. p gde <br /> . ....,, _ <br /> z v-- <br /> ‘,„... . <br /> State: eAre—I r ZIPer97,5(-0 <br /> ...,,,- <br /> '-'•"",--- <br /> 0 <br /> Email: <br /> ... ,... <br /> U.I , _ _Right of7, Z S 1-1 Yes urvivorship: ' 0 No <br /> Date: F---4.?_,D3 <br /> - 7-Signaturen, <br /> 0 Trust 0 Guardian 0 Business--. , 0 Person <br /> - , LegalName:1 Phone: <br /> • (las(.first.middle) <br /> _ ce <br /> I" -Mailing Address: 1 <br /> 1 'Z <br /> ` State: ) ZIP: <br /> ' .City: _ . _ i <br /> 0 — --- - <br /> Email: <br /> LLi ' Right of 12 Yes 0 No ._. <br /> Z Survivorship:; <br /> - Date:- <br /> r- Signature: 1 <br /> _ ‘ <br /> l <br /> 0 Person El Business El Trust E Guardian <br /> v• %.4 <br /> ':f.17k4 <br /> Legal Name: <br /> Phone: <br /> , <br /> -en ' (last,first,middle) <br /> 1111 Mailing Address: <br /> Z <br /> City: State: ZIP: <br /> , Email: <br /> Right of <br /> LH---' <br /> z Yes 0 No <br /> r-Z--, Survivorship: <br /> --------;-;- <br /> Signature: Date: <br /> 0 Person El Business 0 Trust 0 Guardian <br /> Legal Name: <br /> Phone: <br /> (last,first,middle) <br /> -it II4' Mailing Address: <br /> City: <br /> I State: ZIP: <br /> , <br /> ,- Email: <br /> 1 v.,IAJ 1 Right of r--ies El No Survivorship: 1_1 y <br /> Signature: <br /> Date:A - ' <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 1 <br /> 1 <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 approve4.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 /> Paogi <br />