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..3•. ..r..t a. .,:h:ti.a',v:�?".^ �. r ti�:tia,. ..t"•c A�K.- c Ni.,T`""'"- ��.lsi:}i�`;v��zg� K'i X� �"S. 4a :cif <br /> ;rhn;; shi.+,��{x•�.ltir"ti.�t.` ''.Iii l� .�`:-fF ,t �., n,h5 1 b!a.Cs.-�edy .,/�i•:L-`•:'�< ..a�.$.t�.;....�..j+.{.. i\�.>Z''tt y: r S.ff '"i tl."`CWr��"'�r.�/4 t,�4Tly`:�,A,K,S?.�'�,f� <br /> i4.?itr s r ,r<„nt t� int cx. t��,xsa SNE NSEC RI (.� TE1 S 7 �1- RSAci s• Yyn� v� � �, iml7l �} <br /> � �' i h I j S.�''3 j � r` h�C'sy...�:, i?-.^-.�..Xd�o(.?s'6.b'3.4 L���:,S.�S:i�} �•1 .��ul�lJ,,s�x., A3�'R Y^v'1 ..iiyan.•,.+ea a.ei'.�'�,nwr:��R,n�Ftht`>. <br /> Security-interest holder name: <br /> m, Mailing address: <br /> L. <br /> C.) <br /> Security-interest holder name: <br /> ,°- Mailing address: <br /> V <br /> 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 the <br /> sale/change of ownership. <br /> I understand that the home cannot be relocated without first completing this form and purchasing a trip permit from the <br /> State of Oregon,Building Codes Division or one of its county agents. <br /> c 1 understand that the seller/owner is responsible for submitting this Ownership Document Application to the State of <br /> Oregon, Building Codes Division or one of its county agents within 30 days after closing of the sale,and that all <br /> buyers and sellers will be notified by mail when the application is completed.I understand that,should the seller/owner <br /> fail to file this Ownership Document Application within 30 days,I may complete the filing[ORS 446.641(1)]. 1 further <br /> O understand that each lessor,mortgagee,trust-deed beneficiary,lien holder of record,and security-interest holder must <br /> be listed on this notice,or,if none are listed,the manufactured structure must be free and clear of all mortgages,deeds <br /> of trust,security interests,and liens. <br /> Buyer/new owner name(print): 0 Right of survivorship Buyer/new owner signature: Date: <br /> ADAM SMITH <br /> P Buyer/new owner name(print): 0 Right of survivorship. Buyer/new owner signature: Date: <br /> 0 <br /> • Buyer/new owner name(print): ❑Right of survivorship Buyer/new owner signature: Date: <br /> 1.7 <br /> ai <br /> Buyer/new owner name(print): 0 Right of survivorship Buyer/new owner signature: Date: <br /> Seller/current owner acknowledgement of sale/change of ownership <br /> Application must be accompanied by the appropriate valid County Manufactured Honie 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 of <br /> ownership by signing the ownership document or DMV title or completing the section below.Security-interest holders <br /> may elect to acknowledge the sale/change of ownership,but maintain their security interest until such time as they no <br /> longer have an interest in the home. <br /> Seller/current owner affidavit 1 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 of <br /> its county agents within 30 days of the closing of the sale[ORS 446.641(1)]. <br /> 440-2952(7r'17/COM) Page 4 <br />