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<br /> Security-interest holder name: , i
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<br /> a Buyer/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
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<br /> =4' the sale/change of ownership.
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<br /> l'a I understand that the home cannot be relocated without first completing this form and purchasing a trip permit from
<br /> the State of Oregon,Building Codes Division or one of its county agents.
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<br /> :- g I understand that the seller/owner is responsible for submitting this Ownership Document Application to the State
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<br /> te of Oregon,Building Codes Division or one of its county agents within 30 days after closing of the sale,and that all
<br /> 44i buyers and sellers will be notified by mail when the application is completed. I understand that, should the
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<br /> pa, seller/owner fail to file this Ownership Document Application within 30 days, I may complete the filing [ORS
<br /> • ..,0 446.641(1)]. I further understand that each lessor, mortgagee, trust-deed beneficiary, lien holder of record, and
<br /> a security-interest holder must be listed on this notice,or, if none are listed,the manufactured structure must be free
<br /> rj and clear of all mortgages,deeds of trust,security interests,and liens.
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<br /> .• 3 P Buyer/new ower name(print) [ Right of survivorship B er/new or75.(s)iirature: Date:
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<br /> Buyer/new owner name(print) EV/Right of survivorship 4yer/n w owner signature: Date:
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<br /> .r..„ Buyer/new owner name(print) 111 Right of survivorship Buyer/new owner signature: Date:
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<br /> Buyer/new owner name(print) 111 Right of survivorship Buyer/new owner signature: Date:
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<br /> Seller/current owner acknowledgement of sale/change of ownership
<br /> Application must be accompanied by the appropriate valid County Manufactured Home Notification form.
<br /> All owners must release their interest or acknowledge this sale/change of ownership in the structure in order to
<br /> complete this application.All current owners,including security-interest holders,must acknowledge the sale/change
<br /> of ownership by signing the ownership document or DMV title or completing the section below. Security-interest
<br /> holders may elect to acknowledge the sale/change of ownership,but maintain their security interest until such time as
<br /> they no longer have an interest in the home.
<br /> Seller/current owner affidavit I affirm that I am the current owner of this structure and acknowledge that the seller is
<br /> responsible for submitting notice of sale/change of ownership to the State of Oregon Building Codes Division or one
<br /> of its county agents within 30 days of the closing of the sale[ORS 446.641(1)].
<br /> 440-2952(7/17/COM) •
<br /> OR Title Application-12/2017-TitleApp11211 Page 4 004021600-00002
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