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1417466 <br /> I further certify that each lessor,mortgagee,trust-deed beneficiary, lien holder of record,and security-interest <br /> holder has been listed on this notice, or if none are listed,that this structure is free and clear of all mortgages, <br /> deeds of trust, security interests,and liens and that I have the legal right to sell this manufactured structure. <br /> Seller/current owner name(print) Se • curre,t owner signature: Date: NI I release my interest in this structure. <br /> CLAYTON HOMES ALBANY, <br /> OR �� �� <br /> Phone:(541)967-8555 D I acknowledge this sale/change of ownership, <br /> Email: .TA y but do not release my interest in the structure. <br /> Seller/current owner name(print) Seller/current owner signature: Date: ❑I release my interest in this structure. <br /> Phone: 0 I acknowledge this sale/change of ownership, <br /> Email: but do not release my interest in the structure. <br /> Seller/current owner name(print) Seller/current owner signature: Date: 0 I release my interest in this structure. <br /> Phone: El I acknowledge this sale/change of ownership, <br /> Email: but do not release my interest in the structure. <br /> Seller/current owner name(print) Seller/current owner signature: Date: D I release my interest in this structure. <br /> Phone: I acknowledge this sale/change of ownership, <br /> Email: but do not release my interest in the structure. <br /> SECURITY-INTEREST HOLDER ALREADY ON RECORD(if applicable): <br /> Security holder's name(print) Security holder's signature: Date: ❑I release my interest in this structure. <br /> Vanderbilt Mortgage&Finance, D I acknowledge this sale/change of ownership, <br /> Inc. but do not release my interest in the structure. <br /> Security holder's name(print) Security holder's signature: Date: []I release my interest in this structure. <br /> ED I acknowledge this sale/change of ownership, <br /> but do not release 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/buyers,and security <br /> interest holders). <br /> [i 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 /> []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 both: <br /> (A)the county the home is moving from and <br /> (B)the county the home will be moved to <br /> 0 If recording in or removing from county deed records,you must also submit a copy of the recorded <br /> application(Form 5176 or 5175 found at www.oregon.gov/bcd). <br /> 0 If signing by Power of Attorney,submit a Change Affidavit(Form 5221). <br /> []If this application is being submitted by the seller,you must also submit a bill of sale. <br /> 440-2952(7/19/COM) <br /> OR Title Application-10/2019-TitleApp11211 Page 5 004402474-00001 <br />