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• <br /> SECTION,6 NEW OWNER ACKNOWLEDGEMENT(One name per box),:ti.'. <br /> •❑Person ❑Business ❑Trust ❑Guardian <br /> Legal Name:PIGMAN, VERLYN Phone:509-961-7470 <br /> a, (last,first,middle) , <br /> •,W : Mailing Address:2232 42ND AVENUE SE, SP. #900 • <br /> City.:SALEM State:OR ZIP:97317 .• <br /> Email: • • <br /> • <br /> • <br /> Right of ®Yes ❑No <br /> 'Z• . Survivorship: <br /> . ,';. Signature:v ��,_, � �j ��� Date: ) ' 2 y <br /> k:,...:;: I:Person 0 Business 0 Trust • 0 Guardian • <br /> ..a Le al•Name: <br /> N.: g PIGMAN, GERALDINE Phone: <br /> (last,first,middle) <br /> ==1W ' Mailing Address:2232 42ND AVENUE SE, SP. #900 <br /> : City:SALEM State:OR ZIP:97317 <br /> ' . Email: <br /> LIJ Right of []Yes ❑No <br /> ', , Survivorship: <br /> Signature: G,a, ,,gem_t_' ;t �Q,,t, Date: /1 c Ai 4 <br /> ❑Person [Business 0 Trust 0 Guardian <br /> M Legal Name: Phone: <br /> •; a (last,first,middle) <br /> 111 Mailing Address: <br /> .Y`. City: • State: ZIP:. <br /> Email: <br /> • <br /> W�' Right of <br /> Survivorshi ❑Yes 0 No <br /> `. . - <br /> Y Signature: Date: <br /> :g," ' 0 Person D Business 0 Trust 0 Guardian <br /> :;i'" ;,; Legal Name:. Phone: <br /> '+•`v. (last,first,middle) <br /> W 4'• Mailing Address: • <br /> 'Y z <br /> .:`$...; City: State: ZIP: <br /> ®r <br /> Email: <br /> rJ.l,: Right of ❑Yes ❑No <br /> Survivorship: <br /> Signature: Date: <br /> • <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 />