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' :- :' �; Affidavit in Support of Change to a Manufactured Home <br /> :ems : <br /> '".„i t Department of Consumer and Business Services • <br /> Building Codes Division <br /> 1535 Edgewater St. NW, Salem, Oregon•Phone: 503-378-4530 •Fax: 503-378-4101 <br /> Web: oregon.gov/bcd <br /> HOME INFORMATION <br /> Home ID number(if known):265356 DMV X-plate number(if known): <br /> AFFIDAVIT INFORMATION <br /> This affidavit can be used to support ownership changes without the applicant being required to submit legal documents <br /> and must be submitted along with a Manufactured Home Ownership Document Application for New and Used Homes <br /> (440-2952) and a valid tax certification, signed by the county in which the home resides. <br /> APPLICANT/OWNERSHIP INFORMATION • <br /> Applicant's name(last, first,middle):Carl Preusse as Power of Attorney Phone:949-440-2300 <br /> Address: 18006 Sky Park Circle Suite 200 <br /> City:Irvine State: CA ZIP: 92614 <br /> Email: <br /> HOME INFORMATION <br /> Manufacturer: Fleetwood Year: 1991 <br /> Serial number:ORFLM48A12575SP HUD label numbers: ORE204710 <br /> ❑ I am a co-owner of the manufactured home identified above and am listed with a right of survivorship with(list all <br /> owners) <br /> I affirm that • <br /> is/are deceased and that I possess a copy of the death certificate(s). <br /> ❑ I affirm that if the buyer, new owner, or seller is a trust or conservatorship,that I am an authorized representative of <br /> the trust or conservatorship and that I have the legal standing to sign for the trust or conservatorship. <br /> ❑ I affirm that, if ownership is transferring because of a divorce, I have been awarded sole ownership of this <br /> manufactured home and possess a copy of the court order with case number stating that award. <br /> ❑■ I affirm that I have power of attorney for: Brian L. Fitterer Inc. <br /> SIGNATURE . • <br /> I hereby attest that, to the best of my knowledge, this structure is free from all liens and claims of ownership, except as <br /> show in the attached ownership document application. I further attest that the information on this affidavit is true and <br /> correct. -7 <br /> Print name: Carl Preusse Signature: �� 1 1 = — <br /> State of Oregon <br /> County of Marion { <br /> \--...Signed and sworn to (or affirmed)before me on Ju,it2q,2u i e1_(date)by <br /> Nol• 4,1-':11*--), OFFICIAL STAMP <br /> r.--,---% RACHAEL ANN ESTILL <br /> " NOTARY PUBLIC-OREGON <br /> (Not 'r•:;'= COMMISSION NO.969608 <br /> • MY COMMISSION EXPIRES DECEMBER 13,2021 <br /> r DEPART ENT OF <br /> 2BUSI�NESS <br /> SERVICES <br /> nnn_c'li ('/1'7/r'nraf <br />