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357522
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Last modified
1/13/2022 5:59:50 AM
Creation date
5/6/2019 8:59:42 AM
Metadata
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Template:
Assessor
Account Number
357522
Assessor Doc Type
Trip Permit
Secondary Assessor Doc Type
Jacket
Doc Type Date
5/3/2019
MTL
061W29D000600
Assessor Section
Manufactured Structures
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• <br /> g'3 S�i't t,R'-'�'.�'A 7ti f`si:�iy' wi'"!`l�ttis...�i.Vr�� :.r�' �.�,r^,�w��.r�•.�..,�C iffKl tit,•�t`q,'f'`.�it ���"�'>:"aa�:i�°•"Y�,4S.,,• 'ry��F,3}�'5��� �r+�¢a�',,.1�.�4`,i���4JJ"�tw,.c�����StE"'�'{ +j�Klk3�� <br /> 'Al ti 4 1 rx 4 F3 S i m l �"" V l, x faker L. ,'4,y ti <br /> Ww5 k'`(7,5• `�' rf. 5d 'ail C'a''.1' ,':t tSf M4V11 SC ';a 4.41 f'i�w,'t 4mlc RtA:�ga '✓ ,n;a4in''i <br /> Security-interest holder name: <br /> • rR <br /> a • <br /> O Mailing address: <br /> aa <br /> rn <br /> jr Security-interest holder name: <br /> .s. <br /> Mailing address: • <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 /> sate/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 /> e I 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)1.1 further <br /> 4 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 /> Hazel Brush Creek Farms, LLC 01/29/2019 <br /> 147) Buyer/new owner name(print): 0 Right of survivorship Buyer/new owner signature: Date: <br /> o . <br /> J.:, <br /> Buyer/new owner name(print): ❑Right of survivorship Buyer/new owner signature: Date: <br /> • <br /> Oa <br /> Buyer/new owner name(print): ❑Right of survivorship Buyer/new owner signature: Date: <br /> • <br /> • <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 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 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 of <br /> its county agents within 30 days of the closing of the sale[ORS 446.641(I)]. <br /> 440-2952(7/;7/COM) Page 4 <br />
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