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• <br /> f, t <br /> DocuSign Envelope ID:67684644-73C2-4757-9122-31 CE3CFF21 F1 <br /> l•r ECTION 6%'= °;t: :;:;.r;':. I.51:i.0j1IdElIV O.WidERRi'AC : <br /> :..:..... ,....:. ..............:......_......_:�► T=:(On �ine.}ier:box): <br /> EDf;EM N.. 'era <br /> ❑Person ❑Business V.141Tnist ❑Guardian <br /> Legal Name: Saltz, Steven Scott for Seitz Living Trust dated April 29,2019 Phone <br /> : ;;;` (last,first,middle) 928 350-5393 <br /> ILIA Mailing Address: PO Box 661 <br /> 1`.'��: City: Mayer State: AZ ZIP: 86333 <br /> Email: stevesaltz hotmail.com <br /> ::`� = Right of <br /> Z:'• Survivorship: <br /> ,- 1.e:u6:gn..el-by: <br /> Signature: gum, S7,1 Date: 3/22/2024 I 4:47 AM M: <br /> ❑Pebn-2BE6400990B6446... ❑Business CI Trust ❑Guardian <br /> .,N`;:. Legal Name: <br /> •:: .:. (last,first middle) Phone: <br /> •':411:"£ Mailing Address: <br /> :+ ..!: City State: <br /> ZIP: <br /> Email: <br /> :'; Right of ❑Yes ❑No <br /> Survivorship: <br /> Signature: Date: <br /> ❑Person 0 Business 0 Trust <br /> 0 Guardian <br /> `:.4'< Legal Name: <br /> e .;. (last first middle) Phone: <br /> "'1111.;. MailingAddress: <br /> :'Z = <br /> .'�:!'. City State: ZIP: <br /> 3 y Email: <br /> ::•:14 ; Right of ZF: Survivorship ElYes :I No <br /> • <br /> Signature: Date: <br /> ❑Person 0 Business ❑Trust ❑Guardian <br /> :; :4 Legal Name: <br /> (last first middle) Phone: <br /> `ice;" Mailing Address: <br /> :L' City State: ZIP: <br /> Email: <br /> • <br /> ;f LU is Right of ❑Yes 0 No <br /> 'Z Survivorship: <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 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 /> • <br /> Page 3 <br />