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_;SECTION.0:::::, NEW O_WNER ACKNOWLEDGEMENT(One name per box) , <br /> Person ❑Business ❑Trust ❑Guardian <br /> }r,r?R Legal Name:Carver, Charles, C Phone:503-577-6191 <br /> (last,first,middle) <br /> iNle Mailing Address:4402 Gordon St SE <br /> Z <br /> City:Salem State:OR LIP:97317 <br /> rto.; Email:cjesusnus@gmail.com <br /> ,y`°W'° Right of <br /> ',,. j]Yes ❑No <br /> ;'.Z"'' Survivorship: <br /> °' Signature: Date: <br /> -:!?,Ai; ' ❑! Person 0 Business ❑Trust ❑Guardian <br /> jN„i Legal midgName:Carver Donna, F Phone:503-313-7952 <br /> (last,first,middle) <br /> uI,„m Mailing Address:4402 Gordon St SE <br /> =:fig"` <br /> ;:;;fir 4. City:Salem State:OR ZIP:97317 <br /> Email: <br /> W,; Right of ❑Yes ❑No <br /> ``,iz--, Survivorship: <br /> Nr Signature: Date: <br /> • 'r 0 Person ❑Business ❑Trust ❑Guardian <br /> 2 '+L <br /> .M Legal Name: <br /> r iLL Phone: <br /> r f (last,first,middle) <br /> c <br /> :K=� � Mailing Address: <br /> ▪'.':i . City: State: ZIP: <br /> Email: <br /> ; W Right of ❑Yes ❑No <br /> 2 f Survivorship: <br /> k; :a Signature: Date <br /> `'* 0 Person ❑Business ❑Trust El Guardian <br /> *,' Legal Name: Phone: <br /> ; ' (last,first,middle) <br /> W';.-- Mailing Address: <br /> '... City: State: ZIP: <br /> Email: <br /> W' Right of <br /> ❑Yes ❑No <br /> Z ,' Survivorship: <br /> .T.4,,i. 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 Iisted,the structure must be free and clear of all mortgages,deeds of trust,security interests,and liens. <br /> Page 3 <br />