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• <br /> • <br /> SI'aCTIOtd 6 .. NEW OW IER ACKNOWLEDGEMENT(0nenarne per box) <br /> Person ❑Business ❑trust 0 Guardian <br /> Legal \Jn,ti �J <br /> (last first middle) `mil,`' j, t\, Phone:�,��� Q C� � <br /> r�r� Cruel ►` . <br /> w <br /> illailin;Address, ; - 1-,)-(trf�-IT1 - . <br /> • City: r .,ei rt, •r)e_ q=,5 v q" .State: .A ZIP: C�. (. <br /> . Email: h N Lri ln) +`ltAlc1(1 Gl,t'.e,COW( <br /> [i! Right of Yes 0 No • <br /> Z` Survivorship: • <br /> s <br /> Sigi aluee: / �n{/{ f(/J'LC Date: IF '-. <br /> Person 0 Business 0 Trust 0 Guardian • - <br /> y _Legal Name;' Phone: <br /> (last first,Middle) �I lS4'L(;C'� / \� 0''7 5x6 4ql <br /> • <br /> Z "'Mail mg Add, Iress; 1. `idle Ct�� (,f��� k-e . <br /> y-`r City: •' State: ZIP: <br /> • Email: ht,'-vrory\-'� .vi11(K' , £1),1 4'YlC(�C-e, (;�lM • <br /> . ,. Right of D Yes 0 No <br /> • Z'` Survivorship:. <br /> Signature: Date: <br /> 0 Person • ❑Business ❑Trust 0 Guardian - <br /> i- . .Legal Name: <br /> (last,first,middle) Phone: <br /> Mailing Address: ' <br /> City: State: ZIP: , <br /> Email: . <br /> Right of <br /> • Z Survivorship: Les ❑No <br /> Signature: Date: . <br /> • <br /> 0 Person • 0 Business 0 Trust 0 Guardian <br /> Legal Name: <br /> •(last,first,middle) • .- Phone: <br /> L1 Mailing Address: <br /> City: State: ZIP: <br /> 0 <br /> Email: <br /> Lt] Right of Yes ❑No <br /> ' ' Survivorship: <br /> Signature: Date: • <br /> NEW OWNER ACKNOWLEDGEMENT OF SALE/CHANGE OF OWNERSHIP • ' <br /> I affum.that the information provided herein accurately reflects the ownership of the structure at the completion attic 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 str ucture must be free and clear of all mortgages,deeds of trust,security interests,and liens, - <br /> Page 3 <br />