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i <br /> SEGTIONb;:!:: `.: :NEW OWNER:ACKNOWLEDGEMENT'(Onename.perbox) : : <br /> XPerson 0 Business ❑Trust ❑Guardian <br /> ; ;; Legal Name: . <br /> s 'a.. (lastlirst middle) Kennedy, Claude Phone-503-391-0840 <br /> li Mailing Address: 2798 Robins Lane SE <br /> ; '1. City: Salem State: OR ZIP: 97317 <br /> Email: Iansabunchacomcast.net <br /> ;:::W:; Right of <br /> '''''...Z. ... Survivorship: ❑Yes No <br /> Signature: terweig. Date:7/!5 /a-- <br /> Person <br /> 0 Business 0 Trust ❑Guardian <br /> ;,N. Legal Name: Keened Susan Phone: <br /> ` ; (last,first,middle) y. 503-391-0840 <br /> `_,Au Mailing Address: 2798 Robins Lane SE <br /> . City: Salem State: OR ZIP: 97317 <br /> c:i'` Email: plansabunch@comcast.net . <br /> lil Right of ❑Yes No <br /> Survivorship: <br /> Signature: � � J144.44,p_k_e1.1 Date: 7—/5 y <br /> ❑Person ❑Business 0 Trust 0 Guardian <br /> .;i.4.'z Legal Name: • <br /> ,;:;c•. . (last.first,middle) Phone: <br /> 41: Mailing Address: <br /> >' > City: State: ZIP: <br /> Email: <br /> =':1ii!' Right of' ❑Yes ❑N oZ'' Survivorship: <br /> Signature: Date: <br /> 0 Person 0 Business 0 Trust 0 Guardian <br /> 4.:;_; Legal Name: <br /> ::te : (last,first,middle) Phone: <br /> <;ly`.;: Mailing Address: <br /> r' City State: ZIP: <br /> Email: <br /> ii-.11k!i.:. 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 /> Page 3 <br />