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• <br /> • <br /> • <br /> SEG1l0.1.4.*M iV,t l: .;=; '::..NEW.d,WNER'•A'CKNOWLE <br /> XPerson 0 Business . 0 Trust 0 Guardian <br /> ;:` ',;_ Legal Name: <br /> ° t (last,first middle) Rosenthal, William U. Phone: 503-989-2043 <br /> "� 1999 Jansen Way#14 <br /> :. uih •^Mailing Address: . <br /> ::ram.: City: Woodburn state: OR ZIP 97071 <br /> Email: billy senthal icloud.com <br /> " Right of <br /> Z:< Survivorshi : Yes ❑No <br /> Signaturec.. <br /> Date 1.6 6 <br /> 0 Person <br /> rson 0 Business 0 Trust 0 Guardian <br /> ~,tV�- Legal Name: • <br /> c: :: (last,first middle) Phone: <br /> • "ILIA MailingAddress: <br /> <'Z <br /> City: State: ZIP <br /> 0 <br /> Email: • <br /> 6b1. Right of • <br /> ';:Z€ Survivorship: Yes No <br /> • <br /> Signature: Date: <br /> • <br /> ❑Person <br /> 0 Business 0 Trust El Guardian <br /> :m : Legal Name: <br /> i (last; first,middle) Phone: <br /> >1i1:`?: Mailin Address: • <br /> :Z g • <br /> r ' City: State ZIP <br /> :. E nail: • . ' <br /> ::W : Right of <br /> :`i'Z`~ Survivorship: '❑'Yes 0 No _ <br /> • <br /> Signature: Date: <br /> >,.•,' 0 Person El Business 0 Trust <br /> Legal Name: ❑ �� <br /> ..:j:=..beg. (last,first,middle) Phone: <br /> 111 MailingAddress: <br /> '.!. City: State: ZIP:0,i <br /> :. ; Email: <br /> 40 • _ Right of ❑Yes 0 No ' <br /> Z:O. 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 notbeen 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 />