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mow., 1339266 NEW SECURITY-INTEREST'HOLDERS Security-interest holder name: ►�h/kw?c 4.Q. Mailing address: ' 7<713 A t h 1 Pelt(' (-1 ;Grier l'otel0✓2 4-73 Security-interest holder name: c. Mailing address: ss Buyer/new owner acknowledgement of sale/change of ownership I affirm that the information provided herein accurately reflects the ownership of the structure at the completion of the sale/change of ownership. EI understand that the 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. I understand that the seller/owner is responsible for submitting this Ownership Document Application to the State 3 of Oregon,Building Codes Division or one of its county agents within 30 days after closing of the sale,and that all e buyers and sellers will be notified by mail when the application is completed. I understand that, should the 1-; seller/owner fail to file this Ownership Document Application within 30 days, I may complete the filing [ORS g. 446.641(1)]. I further understand that each lessor, mortgagee, trust-deed beneficiary, lien holder of record, and security-interest holder must be listed on this notice,or,if none are listed,the manufactured structure must be free and clear of all mortgages,deeds of trust,security interests,and liens. Buyer/new owner name(print) Right of survivorship Bu ew caner s •atur= Date: cs Wi e Buyer/new owner name(print) 0 Right of survivorship Buyer owne Date: e, Buyer/new owner name(print) 0 Right of survivorship Buyer/new owner signature: Date: Buyer/new owner name(print) 0 Right of survivorship Buyer/new owner signature: Date: Seller/current owner acknowledgement of sale/change of ownership Application must be accompanied by the appropriate valid County Manufactured Home Notification form. All owners must release their interest or acknowledge this sale/change of ownership in the structure in order to complete this application.All current owners,including security-interest holders,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 sale/change of ownership,but maintain their security interest until such time as they no longer have an interest in the home. Seller/current owner affidavit I 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 30 days of the closing of the sale [ORS 446.641(1)]. 440-2952(7/17/COM) OR Title Application-10/2018-TitleApp11211 Page 4 D04I86045.00002