Manufactured Home Bill Of Sale/change Page 2
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3Buyer/new owner name (Last, first, middle):
Buyer/new owner name (Last, first, middle):
Notify
Notify
Mailing address
Same as above
Mailing address
Same as above
NEW SECURITY-INTEREST HOLDERS
Security-interest holder name:
Mailing address:
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.
I understand that the home cannot be relocated without first completing a County Manufactured Home Notification
and Tax Certification Form for Used Homes, along with purchasing a trip permit from the State of Oregon, Building
Codes Division or one of its county agents.
I affirm that if the buyer/new owner is a trust, that I am an authorized representative of the trust and have the legal
standing to sign for the trust.
I understand that the seller/owner is responsible for submitting this Bill of Sale/Change Application to the State of
Oregon, Building Codes Division or one of its county agents within 30 days after closing of the sale, and that all
buyers and sellers will be notified by mail when the Bill of Sale is completed. I understand that, should the
seller/owner fail to file this Bill of Sale/Change 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
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
Buyer/new owner signature:
Date:
Buyer/new owner name (print):
Right of survivorship
Buyer/new owner signature:
Date:
Buyer/new owner name (print):
Right of survivorship
Buyer/new owner signature:
Date:
Buyer/new owner name (print):
Right of survivorship
Buyer/new owner signature:
Date:
440-2952 (2/17/COM)
Page 2
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