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- I <br /> Docusign Envelope ID:BBA8973C-AD5B-4531-AF00-8AF199B66FCB <br /> SECTION 6 NEW OWNER ACKNOWLEDGEMENT(One name per box) <br /> •Person ❑Business ❑Trust ❑ Guardian <br /> Legal Name: <br /> NICHOLL H HILL Phone:971-218-0013 <br /> (last,first,middle) <br /> W Mailing Address: 1904 5TH ST, NE <br /> City:SALEM State:OR ZIP:97301 <br /> 0 <br /> Email:NICHOLL0130HELMS@GMAIL.COM <br /> ud Right of Yes ❑No Nichol) Hill <br /> Survivors • •Sianed by: <br /> Signat r ,(J(t, Date:9/29/2025 11:59 PM PDT <br /> DADC3597028A416... <br /> E Person ❑Business E Trust ❑Guardian <br /> Legal Name: <br /> N <br /> `_ Phone: <br /> .z (last,first,middle) <br /> Mailing.Address: <br /> • Z <br /> City: • State: ZIP: <br /> Email: <br /> W Right of ❑yes ❑No <br /> Z :. Survivorship: <br /> Signature: Date: <br /> ❑Person ❑Business ❑Trust ❑Guardian <br /> m " Legal Name: <br /> Phone: <br /> (last,first,middle) <br /> =LN Mailing Address:�Z <br /> City: State: ZIP: <br /> 0•`. <br /> Email: <br /> W Right of ❑Yes ❑No <br /> Z Survivorship: <br /> Signature: Date: <br /> ❑Person ❑Business ❑Trust ❑ Guardian <br /> Legal Name: " Phone: <br /> (last,first, middle) <br /> Mailing Address: <br /> City: State: ZIP: <br /> 0 <br /> Email: <br /> Right of ❑Yes ❑No <br /> Z Survivorship: . <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 />