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1539023 <br /> 4Etti41 6 MEW OWNe A C I ZED,GEMANT of a <br /> _ <br /> l <br /> " r Person r Business n Trust C Guardian <br /> Legal Name: Mun er Bert <br /> ; 1�.It` past,first,middle) g Phone: <br /> $'Z; Mailing Address: ?)5C-:11,0 D Vz.s an-k-1 a.om <br /> - City:(I)c =t'._S State: ( ZIP: Ull`-'2 <br /> ,- Email: <br /> ' Right of E Yes r No <br /> Survivorship: <br /> Z.. Signature: &t..../ /7 <br /> i ).."- G Date:/e —4--2Q 3 <br /> [Person [Business Trust <br /> eV ❑ [Guardian <br /> ' , Legal Name: Munger Melody Phone: <br /> (jl past,fast,middle) - <br /> Sc.:) .�'(� �^f�iGi <br /> i Mailing Address: <br /> �-�. City: 6 cdc State: (- ZIP: GI�L <br /> - Email: <br /> Right of ryes (—No <br /> z'`J Survivorship: <br /> Signature: n. A ) 1L4-yl .— Date: l0-9- 2 Oz <br /> M ' [Person [Business ❑Trust [Guardian <br /> -ft.:: Legal Name: Phone' <br /> _[ :,. (last,fast,middle) <br /> Mailing Address: <br /> ICity: State: ZIP: <br /> Email: <br /> �` Right of <br /> LV Survivorship: r Yes r No <br /> Signature: Date: <br /> r Person Business�.: - r ❑Trust r Guardian <br /> L •Legal Name: Phone' <br /> Oast,first,middle) , <br /> Z,. Mailing Address: <br /> City: State: ZIP: <br /> Email: - <br /> Right of <br /> Lit <br /> z Survivorship: r Yes r 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 <br /> change of ownership.I understand that the home cannot be relocated without first completing this application and purchasing a trip <br /> permit 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, <br /> I 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 /> 1 <br /> 440-2952(11/22BCD) Page 3 <br /> OR Title Application-7/2023-TitleApp 11211 004808919-00002 <br />