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NEIN°SECURITYrINTEREST HOLDERS.'h ° 1 �, Security-interest holder name: R N/A a Mailing address: v Security-interest holder name: Mailing address: Buyer/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 E sale/change of ownership. EI understand that the home cannot be relocated without first completing this form and purchasing a trip permit from the aState of Oregon,Building Codes Division or one of its county agents. 0 I understand that the seller/owner is responsible for submitting this Ownership Document Application to the State of 0 Oregon,Building Codes Division or one of its county agents within 30 days after closing of the sale,and that all [ buyers and sellers will be notified by mail when the application is completed. I understand that,should the seller/owner fail to file this Ownership Document Application within 30 days, I may complete the filing[ORS 446.641(1)]. 1 further understand that each lessor,mortgagee,trust-deed beneficiary, lien holder of record,and security-interest holder must be listed on this notice, or,if none are listed,the manufactured structure must be free and clear of all mortgages,deeds of trust,security interests,and liens. Buyer/new owner name(print): 0 Right of survivorship Buyer/new owner signature: Date: CHERRI LYONS Buyer/new owner name(print): ❑t Right of survivorship Buyer/new owner signature: Date: 0 JERRY LYONS Buyer/new owner name(print): ❑Right of survivorship Buyer/new owner signature: Date: a Buyer/new owner name(print): ❑Right of survivorship Buyer/new owner signature: Date: Seller/current owner acknowledgement of sale/change of ownership Application must be accompanied by the appropriate valid County Manufactured Home Notification form. All owners must release their interest or acknowledge this sale/change of ownership in the structure in order to complete this application.All current owners, including security-interest holders,must acknowledge the sale/change of ownership by signing the ownership document or DMV title or completing the section below. Security-interest holders may elect to acknowledge the sale/change of ownership,but maintain their security interest until such time as they no longer have an interest in the home. Seller/current owner affidavit I affirm that I am the current owner of this structure and acknowledge that the seller is responsible for submitting notice of sale/change of ownership to the State of Oregon Building Codes Division or one of its county agents within 30 days of the closing of the sale[ORS 446.641(1)]. 440-2952(7/17/COM) Page 4