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SECTION 6 NEW OWNER ACKNOWLEDGEMENT(One name'per box) <br /> ❑Person ❑� Business ❑Trust ❑Guardian , <br /> ✓ Legal Name:West Jefferson Inc. Phone: <br /> CC (last,first,middle) <br /> W Mailing Address:4194 71st. Ave. <br /> City:Salem State:Or ZIP:97317 <br /> 0 Email: <br /> W Right of .Yes ❑No <br /> Z • Survivorship: <br /> Signature: Date: <br /> 0 Person 0 Business 0 Trust 0 Guardian <br /> N Legal Name: Phone: <br /> -� (last,first,middle) <br /> Z Mailing Address: <br /> City: State: ZIP: <br /> 0 <br /> Email: <br /> W- Right of Li ❑No ' <br /> Z Survivorship: <br /> Signature: Date: <br /> 0 Person 0 Business 0 Trust ❑Guardian <br /> `. <br /> M ' Legal Name: <br /> Phone: <br /> (last,first,middle)fa <br /> CZ <br /> Z Mailing Address: <br /> City: State: ZIP: <br /> 0 Email: <br /> LLLI Right of ❑Yes ❑No <br /> Survivorship: • <br /> Signature: Date: <br /> ❑Person 0 Business ❑Trust 0 Guardian <br /> :d' Legal Name: Phone: <br /> (last,first,middle) • <br /> la Mailing Address: <br /> Z <br /> City: State: ZIP: <br /> 0 <br /> Email: <br /> u.iRight of <br /> Z ❑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.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 clays 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 />