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SECTION 6 NEW OWNER ACKNOWLEDGEMENT(One narne;erhox) , ❑Person , 0 Business 0 Thin ❑Guardian Lesal atnii . ail:.rrst middle (�( o '1 rCi�G✓k(�'j� (�l\!1� Pk �/ra Li �( Phone: J, Alatlin,, ekddrras: 01.0D " 44,1 _ J C cC.., ��- City: Sot,, .A State: a . . ZIP: •. " Email: pc pce a. pcin;� atiSscap,im, rim . Right of ®Y 0 No 2`, Survivorship: 'Signature ' lip"' a Date: El Person ❑Business ❑Trust- 0 Guardian iy 'Legal Maine: t>:,', (last,first,middle) I Phone: Iii Mail in Address: City: State: ZIP: �i` - Email: f: Right of lIYes ❑No -, Survivorship: Stsinalure:" I Date: ❑Person ❑Business ❑Trust ❑Guardian -;;m 'Legal Name: (last,first,middle) Phone: "' �' e. 11J Mailing Address: t City: State:. ZIP: Email: ►si: Right of Survivorship: �Yes u No Signature: Date:, ❑Person ❑Business 0 Trust 0 Guardian q° Legal Name: t , (last,first,middle) Phone: uJ Mailing Address: Z City: State: I ZIP: 4 0 Email: lii Right of No Survivorship: �Yes Signature: Date: NEW OWNER ACKNOWLEDGEMENT OF SALE/CHANGE Or OWNERSHIP I affirm that the information provided herein accurately reflects the ownership of the structure at the completion of the sale or change of ownership.I understand'that the home cannot be relocated without first completing this application and purchasing a trip permit from the Building Codes Division or through one of its county agents. I understand that the seller/owner is responsible for submitting this application within 3 0 days after the close of the sale,and that all ' buyers and sellers will be notified by mail when the application is approved.If the application has not been submitted after 30 days,I may complete the filing under ORS 446.64(1), I understand that each lessor,mortgagee,trust-deed beneficiary,lien holder of record,and security interest holder must be listed on - this notice.If none are listed,the structure must be free and clear of all mortgages,deeds of trust,security interests,and liens. Pale 3