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SECTION 6 NEW OWNER ACKNOWLEDGEMENT(One name per box) <br /> Person ❑Business <br /> 0 Trust ❑Guardian <br /> r., Legal Name: <br /> W (last,first,middle) S "k F2 Si74 J Phone: 97/.2� ' SD� <br /> Z Mailing Address: /� w. 7 is/ �9 � <br /> O / City: f v o o eQ (/Jc t..►reve__State: � ` ZIP: .97v 7/ <br /> Email:g S 1U%L . <br /> W Right of 7�` I �ciu..�� ���� 6 +,.ties.` L. �v�,r�t <br /> a. Survivorship: es ❑No <br /> Signature: c2,.... �1 Date: A.. a/.Z <br /> erson ❑Business <br /> Le al Name: �Trust El Guardian <br /> N :: g - <br /> cC (last,first,middle) A-1- jL_ 1 v S r I Phone: <br /> a 4: Mailing Address: � 70 9 g <br /> : .• ` City: w State: OIZ I ZIP: �77v 7/ <br /> Email: <br /> W : Right of <br /> .• `.2. Survivorship: s El No <br /> Signature: �? •/ <br /> g../. > c , 2 j Date: / C- <br /> ❑Person ❑Business ❑Trust <br /> El Guardian <br /> Legal Name: <br /> (last,first,middle) I Phone: <br /> W Mailing Address: 1 <br /> -Z 1 <br /> City: <br /> State: I ZIP: <br /> Email: <br /> Right of <br /> Z. Survivorship: Yes 0 No <br /> Signature: I I <br /> Date: <br /> ❑Person ❑Business <br /> Legal Name: 1 Ej Trust 0 Guardian <br /> ''% . ` g <br /> (last,first,middle) I Phone: <br /> W Mailing Address: <br /> ;'' City: <br /> ..`: I State: I ZIP: <br /> _ Email: <br /> W Right of <br /> Z-:` Survivorship: El Yes ❑No <br /> Signature: I 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 />