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Lane County Clerk 2022-010141 <br /> Lane County Deeds &Records <br /> After recording return to: Western Title 03/03/2022 02:00:00 PM <br /> 497 Oakway.Suite 340 RPR-APPLEXMICnt=1 Stn=8 CASHIER 12 2pages <br /> Eugene, OR 97401 $10.00$11.00$10.00$61.00 $92.00 <br /> Send all future tax bills to: No Change <br /> • APPLICATION TO REMOVE <br /> MANUFACTURED HOME FROM <br /> COUNTY DEED RECORDS <br /> • <br /> YEAR MAKE HUD NUMBER VIN/SERIAL NUMBER WIDTH LENGTH <br /> 1994 GOLDEN STATE SN14261AB 26 66 <br /> HOME ID NUMBER RECORDERS DOCUMENT NUMBER MAP&TAX LOT NUMBER <br /> LI 05912/EM06424 1994-44010 19-01-07-00-02203 <br /> LEGAL DESCRIPTION: • <br /> Please list the legal description of the land upon which the structure is located in the space below.This may either be a copy of the deed or a description of the <br /> property as recorded in the county deed records:(Attach additional sheets, if needed) <br /> SEE ATTACHED EXHIBIT"A" <br /> If there is a secured interest in the property(land and manufactured structure),list the names and addresses of all security interest holders,mortgagees,trust deed <br /> beneficiaries,or lien holders of record holding any interest in the land and manufactured structure in the spaces below.All secured parties must sign and approve <br /> this form.If there are more than two secured parties,provide the names and addresses and approval signatures on a separate sheet of paper and attach to this form. If <br /> there are none,write"none". <br /> **UWe cern that the statements made on this application are true to the best of my/our knowledge.All mortgagees, <br /> fy y g trust deed beneficiaries,lien holders of <br /> record and security interest holders are listed,or if them arc none,I have certified this by writing"none"in the space provided. <br /> OWNER INFORMATION: <br /> PRINTED NAME OF OWNER(S) <br /> CARRIE L.WAGNER <br /> SIG TURF OFOWNE SITUS ADDRESS <br /> (,(,,� 83456 Rattlesnake Rd, Dexter OR <br /> SIGNATURE MAILING ADDRESS <br /> SECURED PARTY INFORMATION: <br /> NAME OF SECURED PARTY <br /> ADDRESS OF SECURED PARTY <br /> SIGNATURE/APPROVAL OF SECURED PARTY' <br /> *Owner and Secured party signatures must be notarized.Attach additional sheets if necessary. <br /> NOTARY: <br /> State of Oregon County of Lane <br /> The foregoing instrument was acknowledged before me this 2 day of <br /> March ,2022 by Carrie L.Wagner . <br /> Signature of Notary Public -� <br /> s:!;., OFFICIAL STAMP <br /> 3- � TONYA RAE SILKE <br /> My commission expires: �- :�'=�-•��' <br /> ��+ NOTARY PUBUC-0OREGON <br /> `�;•;� COMMISSION NO.1010181 <br /> • MY COMMISSION EXPIRES MARCH 14,2025 <br /> a'' ' This certification Is being submitted for recording to the county clerk for the county in which the real property is located. <br /> •B A copy of said recorded document Is being provided to the State of Oregon Building Codes Division or one of its county <br /> y,�'S rivi agents,along with the County Manufactured Home Notification and Tax Certification Form for Used Homes and a <br /> 440-5175(1/17/COM) Manufactured Home Bill of Sale/Change Application. <br /> 1 <br />