Fill and Sign the Statement of Contractual Basis Individual Oregon Form

STATEMENT OF CONTRACTUAL BASIS – INDIVIDUAL (Or. Rev. Stat. §87.057(2)) COMES NOW, __________________________________ , as a person who intends to foreclose a lien on property located at and described as ________________________________________________________________________ ________________________________________________________________________ and states the following: 1. The undersigned provided a Notice of Intent to Foreclose pursuant to Or. Rev. Stat. §87.057 to _________________________________ (owner of the property upon which the lien is claimed) on the _____ day of _________________ , ______ . 2. The undersigned received from the owner a demand to furnish a statement of contractual basis for the owner’s obligation, for which a claim will be made in the suit to foreclose. 3. The undersigned hereby provides the following statement of contractual basis for the owner’s obligation within five (5) days of such demand: _______________________________________________________________________ . This the _____ day of ____________ , 20 ______ . ______________________________ Signature _____ _________________________ Type or Print Name Certificate of Delivery I, _____________________________________, hereby certify that I have delivered this day a true and correct copy of the foregoing to ___________________________________ by: ( ) Personal Delivery ( ) Mailing a true and correct copy of same by certified or registered U.S. mail, postage prepaid, return receipt requested. So certified this the ______ day of ___________________, 20____. ________________________ Signature Statement of Contractual Basis Page 1 of 1