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DocuSign Envelope ID:A98832F6-AE52-47AF-852(4, E4EB65F6AA t <br /> .. 1;>`:. Y#'dtlr� :}�''"t-. 4.�.f, 'T1kru - y as.,3cxk ;."»�£�'t{ ??Fred 5...��r5,gr�1��y}� ' �}?}'c�y� st"f�Vsyr?.�. 'f1:t.. `e <br /> �-. .�4� as �, s ��t,=,fin,'._.•>; rirk- _.ara.:�s'�` .m, ymo4' .,. .+' _ t-a�ar �?,�'�,-,�'%s.$?a?`yxt"�e .s��`�'��1�, �X'��l �" <br /> Security-interest holder name: <br /> -sr <br /> Mailing address: - <br /> v <br /> Security-interest holder name: <br /> • <br /> Mailing address: <br /> • <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 /> sale/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 /> (40 <br /> -▪a I understand that the seller/owner is responsible for submitting this Ownership Document Application to the State of <br /> rf' 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 /> .0 fail to file this Ownership Document Application within 30 days,I may complete the filing[ORS 446.641(1)].I further <br /> 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): ❑Right of survivorship Buyer/new owner signature: Date: <br /> r—Docuslgnedby: 11/12/2019 1 3 39 PM MS <br /> Rex L.Beard <br /> rt;,, 6.G64 <br /> FDE 14Cffi9577A11... <br /> :4) Buyer/new owner name(print):. ❑Right of survivorship Buyer w owner signature: Date: <br /> ,- DocuSIgned by: <br /> Joyce L. Hernzndez-Beard h, � J,"7 5: � 11/12/2019 3:47 PM n <br /> `—,INFO 14C829sR411... � Date: <br /> 1, Buyer/new owner name(print): ❑Right of survivorship Buyer/new owner signature: <br /> (11 • <br /> lt, Buyer/new owner name(print): ❑Right of survivorship Buyer/new owner signature: Date: <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(7/17/COM) Page 4 <br />