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i 1360135 NEW SECURITY-INTEREST HOLDERS Security-interest holder name: CS Mailing address: a. Y GA w Security-interest holder name: Mailing address: , 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. CI E. I understand that the home cannot be relocated without first completing this form and purchasing a trip permit from d the State of Oregon,Building Codes Division or one of its county agents. cI 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 1-1 i buyers and sellers will be notified by mail when the application is completed. I understand that, should the g. seller/owner fail to file this Ownership Document Application within 30 days, I may complete the filing [ORS 446.641(1)]. I further understand that each lessor, mortgagee, trust-deed beneficiary, lien holder of record, and 44 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 @int) pl, ight of survivorship Buyer/new owner signature: nniee Date: Mildred B 3 cu Buyer/new owner name(print) Right of survivorship Buyer/new owner signature: Date: r' •r r t i<IQJ2 02-.9-7- il Buyer/new owner name(print) 0 Right of survivorship B yer/new eyvner signature: Date: OP Buyer/new owner name(print) fl 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/I9/COM) OR Title Application-]0/2019-TitleApp11211 Page 4 004233606-00001