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i <br /> SECTION,6 . INEWrOWNERaACKNOWLEDGEMENT(One name per box). <br /> ii Person ❑Business 0 Trust 0 Guardian <br /> 0.1. 19gal Naln <br /> last trsl middle C7 4-se.GdST Phtine, <br /> Lu 1, Mailing Address: <br /> ZZ ig633 0140 MdNNi> A IUD 5E. <br /> ' Ciry:.? s_riyroeti State r Ol Z q7 3?f'3. <br /> Email:444k t&it/l/ti.1041 <br /> W Right of De Yes 0 No <br /> X Survivorship: s�y� <br /> ,Signature:`�� %� % Date 6-'/-20 <br /> A Person 0 Business 0 Trust ❑Guardian <br /> fV' Legal Name: t 7 / g <br /> ce (last,firs!,middle) r a/ O/ / ehr`s�/ ` ,8 -e, Phone' <br /> =Z. Mailing Address: j �J// r ,, 61 6-6 <br /> S' ` City: ' `exzz[ice State: t� ZIP: g7rgf' <br /> ® < rr <br /> Email: w 6c.%"7 2: CGS <br /> W Right of X Yes N10 <br /> _Z Survivorship: <br /> Signature: � "✓s'.00 4::W.4 Date: die 2 <br /> I:Person ❑Business ��CJ ❑Trust ❑Guardian <br /> rn Legal Name: Phone: <br /> yoc (last,first,middle) <br /> Mailing Address: <br /> . '. City: State: ZIP: <br /> Email: <br /> W Right of m y, ❑No <br /> Z. , Survivorship: <br /> Signature: Date: <br /> 0 Person ❑Business ❑Trust ❑Guardian <br /> v., Legal Name: Phone: <br /> (last,first,middle) <br /> Mailing Address: <br /> City: State: ZIP: <br /> Email: <br /> Right of ❑Yes ❑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.Tunderstand 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.under-stand 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 noticed 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 he 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 />