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NEW SECURITY-INTEREST HOLDERS Security-interest holder name: Mailing address: Z.5 Security-interest holder name: Mailing Address; vi Crli _ •t II Buyerinew ownercknawledgenient of sale/change of:ownership l affirm that the information provided herein accuately reflects the ownership of the structure at the completion of the sale/change of oWnersl ip. I understand that,tile•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. S l understand that:tli,.e.:sellerlowrier:is responsible for submitting this Ownership Document Application to the State of gi 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 he:notaied by mail.when the application is completed.I understandthat,should the-seller/owner t, fail to file this Ownership Doctiment.Application within 30 days,I,may�complete the filing[ORS 446.641(1)1 I further q understand that each lessor,mortgagee,trust-IA.0d beneficiary,lien holder of record,and security interest holder must Ibe listed on this notice,or,if none are listed,the manufactured structure must befree and clear of all mortgages,deeds of trust,security interests,and:liens. 13+ryer/rietiv owner name(print): 0 Right of survivorship Buyerhtery owner, i;n ti Date: K"'"f F /`?i'/. kr J." �x r Buyer/new owner name(print): [J Right of survivorship Buyer/new owner sig ore: Date: •r • Bu_yerincw owner name(print):: ❑Right of survivorship Buyer/new owner signature: Date Buyer/new:ownername(print); 0 Right:of survivorship Bnyerinew owner signature: Date: Seller:/current aiWner Acknowledgement.of sale/change of:ownership Application must be accompanied by the appropriate valid County Manufactured Home Notification form. Ail owners:must release.their interest or acknowledge this sale/change of ownershipin the structure in order to complete this applicatinn.All 'current owners, including security-interest hinders,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 salcichan;e of ownership,but maintain their security interest until such tune as they no longer have an interest in the home: Seiler/current owner affidavit T 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 withiin,30:days of the closing of the sale CORS 446.641(1)). 440.2952(7117ICO]"1) Page 4