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I 1 <br /> I further certify that each lessor, mortgagee, trust-deed beneficiary, lien holder of record, ani security-interest <br /> holder has been listed on this notice,or if none are listed, that this structure is free and clear •f all mortgages, <br /> deeds of trust, security interests, and liens and that I have the legal right to sell this manufact red structure. <br /> Seller/current owner name(print): Seller/current owner signature: Date: 0 I release my int rest in this sticture. <br /> LEISURELAND HOMES INC <br /> ;.' <br /> Phone:541-928-1555 a : I acknowledge t is sale/change of ownership, <br /> I <br /> L. —Cf. t_,,,, ❑ but do not relea c my interest in the structure. <br /> Email: mindy21m@comcast.net ' <br /> Seller/current owner name(print): Seller/current owner signature: Date: ❑ I release my int rest in this structure. <br /> ❑ <br /> I acknowledge 's sale/change ofownership, <br /> Phone: j but do not relea.e my interest in the structure. <br /> Email: <br /> Seller/current owner name;(prin y: 'Seller/current owner signature: Date: ❑ I release my int•rest in this structure. <br /> Phone' ❑ I acknowledge- his sale/change of ownership, <br /> but do not relea.e my interest in the structure. <br /> Email: <br /> Seller:/current owner name.(print): Seller/current owner signature: Date: ❑ t release my int•rest in this structure. <br /> • ❑ I acknowledge his sale/change of ownership, <br /> Phone: butdo not release my interest in the structure. <br /> Email: `• <br /> SECURITY-INTEREST HOLDER ALREADY ON-RECORD (If appllcabl ) <br /> Security holder's name(print) Security holder's signature Date: ❑ I release my int rest in this structure. <br /> ❑ I acknowledge his sale/change of ownership, <br /> but do not relea.e my interest in the structure. <br /> Security holder's name(print) Security holder's signature: Date: ❑ I release my int rest in this structure. <br /> I acknowledge tis sale/change of ownership, <br /> but do not relca.c my interest in the structure. <br /> PRIOR TO SUBMITTING,'CHECK THE FOLLOWING: <br /> ❑ Signatures from all applicable parties must be complete(current owners/sellers,new owners/b yers,and security- <br /> interest holders). ` <br /> ❑ A valid tax certification from the county tax assessor, The tax certification form will be provided by the county <br /> office and must be signed by a county official. <br /> ❑ <br /> Any additional documents needed to establish your authority to buy/sell this home as required by ORS 446 <br /> and OAR 918 and.posted at www.oregon.gov/bcd. <br /> If the home is being Moved to a different county, a valid tax certification form is needed from r oth: <br /> ❑ (A) the county the home is moving from and. <br /> (B)the county the home will be moved_to <br /> ❑ If recording in or removing_from county deed records,you must also submit a copy of the recorded <br /> application Tonn'.5176 or 5175 found at www.oregon.gov/bcd). <br /> ❑ If signing by Pow0r of Attorney, submit-a Change Affidavit (Form 5221). <br /> ❑ If this applicationis being submitted by the seller,you.must also submit a bill of sale. <br /> t <br /> } <br /> 440-2952(7/19/COM) - Page 5 <br />