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.,�"��50 rr� tis 4. -1.1 3 Mi� Sa ` '(, ~7s� +e '�..t' •X41,: � weY ' ry2 4 � t ((,,tiy" + .- ' .h� af „ S `• '.. f ^_._. _ 'vsi < daa.. `y...-," . '. ...- .a,9'k s Security-interest holder name: ~• Mailing address: X1 `z� 58 0 I 1't Way so �sLl i )� . f Way hr Feedera! Way , WA- g800e Security-interest holder name: Mailing address: • ',.'<..... Buyer/new owner acknowledgement of sale/change of ownership '-[-affirm that the-information provided herein accurately reflects the ownership of thestructure completion of the, '4t--sale/change-of ownership __ ---------- — ;:7"i ':'`' 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. 4.4 = �r•. . -.ti I understand that the seller/owner is responsible for submitting this Ownership Document Application to the State o f fay 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 `4' 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 ti of trust,security interests,and liens: Y i Buyer/new owner name(print): 0 Right of survivorship t3uy ew; wue si aatnre:. Date:. !'': 1 E.--30_17 f Jose/ V @, Od f 0!r �. ` c '__" E Buyer/new owner me(print): 0 Right of survivorship 4uyer/new.owner-Signature:— ::'t}ate:' I :4,4 ��'' of Buyer/new er/new owner signature: Date: Buyer/new owner name(print): 0 Right }�� m Buyer/new owner name(print): 0 Right of survivorship Buyer/new owner signature: Date: ,ti Seller/current owner acknowledgement of sale/change of ownership Application must be accompanied by the appropriate valid County Manufactured Rome 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%hange 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)]. 410.2952(7/r7/COM; Page 4