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NEW SECURITY-INTEREST HOLDERS �+ Security-interest holder name: Mailing Address.:v cc I • Security-interest holder name: Mailing address: Po I Buyer/ivory Owner aicknowledgernent of sale/change of:ownership jl affirm thatthe information provided herein accurately reflects the ownership of the structure at the completion of the sale/change of oWnership. Y I understand that tile-home cannot be relocated:Without first completing this form and purchasing a trip permitfrom die State of Oregon,Building.Codes.Division or one of its county agents. a S I understand at th :sellerr/oWrier:is responsible for submitting this Ownership Document Application to the State of Oregon, Building Codes Division or one Ohs county agents Within 30daays after closing of the sale,'and that all buyers and sellers will be.notaiied by mail when the application is completed.I understand that,should the seller/owner n fail to•file this Ownership Docume nt Application within 38 days,',maycomplete the filing[ORS 446.641(1)1.I further q understand that each lesssor;.mertgagee,trust-.deed beneficiary, lien holder f records and security-interest holder must , be listed on this notice,or,if none are listed,the manufactured structure must befree and;clear of all mortgages,deeds ! 1 of trust,security interests,and liens. • i Buyer/new owner name.(print): I Right of survivorship Buyer/new owner. ign•tur Date: I"- 1.41-i, /?fry tri, �` �°//s/,,?;.,,, Buyer/new,owner name.(print): [J Right of survivorship . Buyerfnew owner sag pre: Date: r S Buyerinew ovrner name.(print)t. D Right of survivorship 13uyTerinew owner:signature: Date:. G M Buyer/nezvuwnername-(print): 0 Right:ofsurvsvorship Buyerinew owner signature; Date: 1 Seller/current owner a::knoWledgem:nt.of saletchange of:ownership Application must be accompanied by the appropriate valid County Manufactured Home Notification form. Ali owners:rtoust:release.their interest or acknowledge this salckhange:of ownership in the structure in order to corn lete-this application.All current owners, including'security-interest holders,most,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 sale/change of ownership,but maintain their security interestuntil.such tune as they no longer have an interest in the home: . • Seller/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 within,3O:days of the Closing of the-Sale[ORS 446.641()). 1 • 44O-2952(7/17/COM) Page 4