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• DocuSign Envelope ID:BC82F0C2-F6EE-4E(.....-dC38-F05F91E29D16 1447112 I further certify that each lessor, mortgagee,trust-deed beneficiary,lien holder of record, and security-interest 1holder has been listed on this notice,or if none are listed, that this structure is free and clear of all mortgages, deeds of trust, security interests,and liens nd that I have the legal right to sell this manufactured structure. I Seller/current owner name(print) ,Se ler/cur owner signature: Date: Ir 1 release my interest in this structure. ORCLAYTON DOMES ALBANY, e/APhone:(541)967-8555 /0/iEmail: 0 1 acknowledge this sale/cbange of ownership, Seller/current owner name(print) Seller/current owner si afore: Date: but do not release my interest in the structure. Q l release my interest in this structure. Phone: Email: E I acknowledge this sale/change of ownership, but do not release my interest in the structure. Seller/current owner name(print) Seller/current owner signature: Date: 0 1 release my interest in this structure. Phone: Email: 01 acknowledge this sale/change of ownership, but do ot release my t in the Seller/current owner name(print) Seller/current owner signature: Date: 0 II release my interest in this structure. structure. Phone: Email: _ I acknowledge this sale/change of ownership, but do not release SECURITY-INTEREST HOLDER ALREADY ON RECORD(if applicable________________/ )my interest in the structure.' Security holder's name(print) Security holder's signature: Date: — Vanderbilt Mortgage&Finance, ❑I release my interest in this structure. Inc' O I acknowledge this sale/change of ownership, Tint ' "' Security holder's name but do not release my interest in the structure.t (P ) Security holder�s signature: Date: E:1 I release my interest in this structure, 0 1 acknowledge this sale/change of ownership, but do not release my interest in the structure.! PRIOR TO SUBMITTING, CHECK THE FOLLOWING: Q Signatures from all applicable parties must be complete(current owners/sellers,new owners/buyers,and security �' r i nterest holders). 0 A valid tax certification from the county tax assessor.The tax certification form will be provided by the county office and must be signed by a county official. 0 Any additional documents needed to establish your authority to buy/sell this home as required by ORS 446 w and OAR 918 and posted at www.oregon.gov/bcd. []If the home is being moved to a different county,a valid tax certification form is needed from both: (A)the county the home is moving from and (B)the county the home will be moved to fl If recording in or removing from county deed records,you must also submit a copy of the recorded ____ __application(Form 5176 or 5175 found at www.oregon.gov/bcd). D If signing by Power of Attorney,submit a Change Affidavit(Form 5221). _ --� • — _ —--• I []If this application is being submitted by the seller,you must also submit a bill of sale. I . 440-2952(7/19/COM) OR Title Application-10/2019-TitleAppl 1211 Page 5 004489498-00002