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• <br /> • <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): er/curr: y r er ture: Date: I release my interest in this structure. <br /> HOMES DIRECT OF OR LLC !� <br /> Phone: 541-928-2083,,` / � / / / ''//I�� }} 3//�/ ❑ I acknowledge this sale/change of ownership, <br /> Email:- li' j F1•, I'-'.U,�{I k€D j yt-(dore • <br /> C but do not release my interest m the structure. <br /> Seller/current ower na a(print): Seller/current own signature: Date: ❑ I release my interest in this structure. <br /> AQrnes• c it - <br /> Phone F-1I acknowledge this sale/change of ownership, <br /> but do not release my interest in the structure. <br /> Email: <br /> Seller/current owner name(print): Seller/current owner signature: Date: ❑ I release my interest in this structure. <br /> Phone: ❑ I acknowledge this sale/change of ownership, <br /> but do not release my interest in the structure. <br /> Email: • <br /> Seller:/current owner name(print): Seller/current owner signature: Date: ❑ I release my interest in this structure. <br /> Phone: ❑ I acknowledge this sale/change of ownership, <br /> but do not release my interest in the structure. <br /> Email: <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 /> ❑ I acknowledge this sale/change of ownership, <br /> 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 /> ❑ 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 /> ❑ 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 /> ❑ 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 /> ❑ 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 /> • <br /> 440-2952(7/19/COM) Page 5 <br />