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c . Docusign Envelope ID:100FADB7-DFOB-421 3C-92D31C39C4D3 SECTION 6 . NEW OWNER ACKNOWLEDGEMENT(One name per k,.- box) Person 0 B e �,. Lega Name; � t• . cc (last,first,middle) �`� -�, t I Phone "'l1• .37 1 Mailing Address: sl t .C,, city' u-rtiNS t. n �( I State Email: - Ma; Right of - survivorship: ❑Yes ❑No Signature: ,-f .441 .;_,,,•,,..vor Date; 8/26/2025 •WPerson 0 Business 0 Dust IN. Legal Name: Oast,fire,middle) -(� ' I Phone: Mailing Address: a 654 NI t City: ("' �--�-- State:(: '4 . ZIP: Email: tal Z . Sun�o� f ❑Yes ❑No Signature: r _ Date; 8/26/2025 0 Person 0 Busies 0 e9' Legal Name: _.--____ — Trust_— ®man ce (last.first•middle) Phone:iii Mailing Address: 0 City: State: ZIP: Email: ua Right of _ Z Survivorship: ®Yes ❑No Signature: \ 0 Person 0 Business ❑Trust o Guardian 14. Legal Name: ix (lea.first,middle) Phone: W Mailing Address: City: I State: ._... 1 ZIP: __ ,- _' Survivorship: Yes 0 No I Date: NEW OWNER ACKNOWLEDGEMENT OF SALE/CHANGE OF 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 from the Building Codes Division or through one of its county agents. a permit ' I understand that the seller/owner is responsible for submitting this application within 30 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'446.640). 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. Page 3