Laserfiche WebLink
• <br /> SECT[---6�'t-4, , * 1 ttE toffifiEii kettli�WLEDGEMEI T(One name pei g. -. ._ r.-Ag <br /> m_...._,v r-e.... <br /> `` : - ■❑Person ❑Business ❑Trust ❑Guardian <br /> 3, ; Legal Name: <br /> ? L{� (last,fist,middle) Edmonds, Anthony Phone: 503-789-4145 <br /> t Mailing Address: 340 NE Crest St, Spc 74 <br /> City: Sublimity State: OR ZIP: 97385 <br /> `- Email: <br /> *111" Right of <br /> ix Yes ❑N� <br /> ,.� Survivorship: <br /> Signature: Date' �� �t' <br /> t ■ Person Business <br /> e , ,_ ❑ ❑ ❑Trust ❑Guardian <br /> v. t Legal Name: <br /> �� Edmonds, Karen Phone: <br /> -, sa '. (last,first,middle) <br /> • b Mailing Address: 340 NE Crest St, Spc 74 <br /> City Sublimity State: OR ZIP: 97385 <br /> Email: <br /> iit�:$, Right of pc Yes ❑No <br /> ‘,• -zfl.k Survivorship: <br /> Zaiii <br /> sue;,,,,` Signature: trot ` �( Dater r/7_ 2 � <br /> ,=- ❑Person ❑Business ❑Trust <br /> a, ,iLL _ ❑Guardian <br /> sue._ <br /> Legal Name: Phone: <br /> Tili (last,first,middle) <br /> r Mailing Address: <br /> A <br /> f.s.,� City: State: ZIP: <br /> F Email: <br /> 6 Right of <br /> ❑Yes ❑No <br /> A• - Survivorship: <br /> R vt Signature: Date: <br /> Autft <br /> ❑Person ❑Business ❑Trust ❑Guardian <br /> Legal Name: <br /> (last,first,middle) Phone: <br /> ' Mailing Address: <br /> r.m$,,7t- <br /> City: State: ZIP: <br /> rt: <br /> Email: <br /> „,,, %-, <br /> li Right of . <br /> `' Survivorship: El Yes ❑No <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 />