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d , • NEW SECURITY-INTEREST HOLDERS • ›, Security-interest holder name: t NONE a Mailing address: NONE Security-interest holder name: NONE o c2. Mailing address: °: NONE r5 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 the sale/change of ownership. I understand that the home cannot be relocated without first completing this form and purchasing a trip permit fro 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 Sta of 0 Oregon,Building Codes Division or one of its county agents within 30 days after closing of the sale,and that all e buyers and sellers will be notified by mail when the application is completed. I understand that,should the seller/ wner a, fail to file this Ownership Document Application within 30 days,I may complete the filing[ORS 446.641(1)1 rther understand that each lessor,mortgagee,trust-deed beneficiary,lien holder of record; and security-interest holdei- ust 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 Buy r/new owner signature: Date: 'U(sar? L it/20,5.&(2_ ��` � 3/z 2-/1- dBuyer/new owner name(print): ❑Right of survivorship Buyer/new owner signature: Date: v � Buyer/new owner name(print): 0 Right of survivorship Buyer/new owner signature: Date: I m � s Buyer/new owner name(print): ❑Right of survivorship Buyer/new owner signature: Date: _ f 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 ordert complete this application.All current owners,including security-interest holders,must acknowledge the sale/chang of ownership by signing the ownership document or DMV title or completing the section below. Security-interest hole may elect to acknowledge the sale/change of ownership,but maintain their security interest until such time as they n 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 s 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)]. L. 440-2952(7/17/COM) Page 4 4 _