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<br /> Docuslgn Envelope ID:5C1COD70-3857-49713-95A3-85DB49305AE8
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<br /> 4E010s,*.,! i-; :.,:miN:.!igi:g.g..140tikrgwiNgiftwci<NlawLEDG.EwiEprrotietiatiie.per:Jsry)0. :;,. .;..i.! ,.:,:.:-:,.;.,..:.,:::...:..
<br /> XPerson p Business D Trust 0 Guardian
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<br /> •h:i-r',..:; Legal Name:
<br /> ,•""'",.:•••••',.• (last first middle),
<br /> Larry Urrutia Phone: 503-910-1971 •
<br /> qi':1015! mailing Address: 25758 Taylor Park Rd. SE
<br /> •::::.::i:M:i::;
<br /> city: Lyons state: .OR ZIP: 97358
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<br /> EnYlil: larryl.n.nancyl@gmail.corn
<br /> Right of . •
<br /> ::•;;z El Yes 0 No
<br /> . ,.,.,......:„„ Survivorship:
<br /> e—noeuqgpcel ky•
<br /> ''.•:.i'.:!;::E......
<br /> Signatur: ton (j vilki.ix Date:7/16/2024 I 8:05 AM MS
<br /> ....!..-:::-:',•:. XPehmyEBCoi51AFD3D42F... El Business
<br /> 0 Trust 0 Guardian
<br /> li44E Legal(last Name)
<br /> Nancy Urrutia • Phone: 503-910-1971
<br /> ,first,middle
<br /> %-' --
<br /> Mailing Address: 25758 Taylor Park Rd. SE
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<br /> •. i.ai - City: Lyons State: OR ZIP: 97358
<br /> : • :0.'.i: - .
<br /> Email: larryj.n.nancyl@gmail.corn
<br /> ,urg Right of ri y r-i N • .
<br /> bOg Survivorshi : 1-1 us I-1 °
<br /> ";;;::!;::::::;•;.: Sinaturef /VW/ UKIIAliCt Date:7/16/2024 I 8:C8 AM MS1,
<br /> ;'.,. .;.!:..! 0 p 2EBCO 1AFD3042F... 0 Business El Trust ED Guardian
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<br /> !.*•:,1;:i: Legal Name:
<br /> (last;first,middle) Phone:
<br /> Mailffig Address:
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<br /> City: State: ZIP:
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<br /> Email: ' , •
<br /> Right of ,
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<br /> • Z•ii Survivorship: Yes No
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<br /> •:.i•Iii4:':::::• Signature: Date: •
<br /> :]'•:!;•:::E:.• 0 Person 1:1 Business 0 Trust 0 Guardian
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<br /> Legal Name:
<br /> .2:itieni.• (last,first,middle) Phone:
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<br /> City: State: ZIP: •
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<br /> Email:
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<br /> Right of
<br /> 21. Survivorship: 0 Yes 0 No
<br /> :.;ii .;: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 listed,the structure roust be free and clear of all mortgages,deeds of trust,security interests,and liens.
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