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, , i p <br /> Docusiyn Envelope ID:C79DC333-31F8-4B3A-9410-07E5C50A5A37 <br /> `;SECtiON>6`:`::° : NEVillOWNERA KNO.WLEDGGEMENr1One1name •erb0101i. `:: :::: <br /> . XPerson ❑Business 0 Trust ❑Guardian <br /> ' LeN•i`: ` gl aniShetler "% Phone:503-559-8628 <br /> i (last, e) ,i d > Yr - <br /> `W'' Mailing Address: PO Box 262 <br /> S ' City: Scotts Mills State: OR ZIP: 97375 <br /> Email: joanieshetler@gmail.com <br /> ::W::: Right of u Yes ❑No <br /> €Z; Survivorship: <br /> ,ed,y. <br /> Signature: knti, ojA tk.t, s Date1O/2/2024 1 5:3 3 AM P <br /> Person 73D3BADDC26F443... Business ❑Trust ❑Guardian <br /> •'W. Legal Name: <br /> (lastfirst,middle) Phone: <br /> :::,1ii:; Mailing Address: <br /> :; City: State: ZIP: <br /> ::" Email: • <br /> :1':;!:!ura Right of �Yes ❑No <br /> Z . Survivorship: <br /> Signature: • Date: • <br /> ❑Person 0 Business 0 Trust ❑Guardian <br /> ' ' LegalName: <br /> : Phone: <br /> : RY.`'_ (last first,middle) <br /> `:W : Mailing Address: . <br /> . t City: State: ZIP: <br /> Email: <br /> ::W Right of ❑Yes ❑No <br /> :12 Survivorship: <br /> Signature: • Date: • <br /> []Person . 0 Business 0 Trust ❑Guardian <br /> . Legal Name: <br /> :te;` Oast.first middle) Phone: <br /> :'W:` Mailing Address: <br /> i}?' City: State: ZIP: <br /> Email: <br /> ` •`N Right of <br /> Z Survivorship: ❑Yes 0 No <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(i). <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 />