Laserfiche WebLink
• <br /> Docusi9n Envelope ID:C79DC333-31 F8-4B3A-9410-07E5C50A5A37 <br /> :;SECTIO '6:::';, ;: ;:: °>: : ° -'NEVI iow.NER'ACKNOWLEDGEMENT(One•naine •erboz)• ro' ::::;° .:•..:: :•::. :: <br /> • >4Peison 0 Business El Trust El Guardian <br /> 1,' Oast,first,middle) Shetler,I�'�,ro1 c, Phone:503-559-8628 <br /> `'W" Mailing Address: PO Box 262 <br /> `rR..: ' City: Scotts Mills State: OR ZIP: 97375 <br /> Email: joanieshetler@gmail.com <br /> X <br /> a`::W~: Right of Yes ❑No <br /> :`•ii:`Z:;: Survivorship:f _Signed by. <br /> Signature: kati, oiAiIAA, stalky. Date3.O/2/2024 15:3 3 AM P <br /> 0 Peln 73D3BADDC26F443... 0 Business 0 Trust D Guardian <br /> . N` Legal Name: <br /> (last first,middle) Phone: <br /> • <br /> W<< Mailing Address: <br /> . :. City State: ZIP: <br /> 0€:r <br /> Email: <br /> W.w; Right of D Yes D No <br /> {.Z Survivorship: <br /> Signature: Date: • <br /> 0 Person ❑Business D Trust ❑Guardian <br /> Legal Name: <br /> (last first middle) Phone: <br /> <:W==: Mailing Address: . <br /> . • !':.:ai: City: State: ZIP: <br /> Email: ' <br /> W::: Right of D Yes ❑No <br /> :Z Survivorship: <br /> Signature: • Date: <br /> D Person . 0 Business ❑Trust ❑Guardian <br /> ..2' ; Legal Name: <br /> (last,first,middle) Phone: <br /> `. W Mailing Address: <br /> a:-: City: State: ZIP: <br /> `" Email: <br /> :':10 Zf-".A Right of <br /> D Yes I-,No <br /> : .Z';: Survivorship: <br /> • <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 />