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• ' s ' :t hh t$r...:.ts •, • -- ci • �,.r..sm..I i n "n ,� rif '�1a s y� 5aY t grf °,sp� ufi tiT" ;.K7.a a ^57} 7T.�•,4 4,{ � ;;;0r�woF _.:' u f _ .. n.s:. (l _iVsP2iA141OC .s.PWA 3 # Securityinterest holder name: Mailing•address:: • .. it' Security-interest holder name: Mailing address: . tko ttx 'I' Buyer/new owner acknowledgement.of sale/change of ownership g i'4.► I affirm thatthe.information provided herein accurately reflects the ownership of the structure at the completion of the sale/change ofowriership. I understand:that the home cannot be relocated without first completing this form and purchasing a trip permit from the State'of Oregon,Building Codes Division or one of its county agents. •! I understand that the seller/owner is responsible for submitting this Ownership Document Application to the State of v Oregon,-Building Codes Division or one of its county agents within 30 days after closing of the sale,and that all L? 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)].I further fjtig understand that each lessor,mortgagee,trust-deed beneficiary,lien holder of record,and security-interest ary, holder must V 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: ® j —,2- d , 02, Buyer/new ner name(print):i (p ' ) ID Right of survivorship Buyer/new owner signature: Date yo � f�D©� a✓ A I d/251 6 7a. Buyer/new owner name(print): D Right of survivorship Bi•r/new owner signature: Date: Buyer/new owner name(print): 1:—.1 Right of survivorship Buyer/new owner signature: Date: • Seller/current owner acknowledgement of sale/change of ownership Application must be accompaniedby theappropriate valid County Manufactured Home Notification form. All ownersnmust 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 ownershipby-signing the:ownership document or DMV title or completing the section below.Security-interest holders may elect to acknowledgellie: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 thatI 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 ofthe sale[ORS 446.641(1)]. • • 440-2952(7/17/COM) Page 4