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• 1446933 I further certify that each lessor, mortgagee, trust-deed beneficiary, lien holder of record, and security-interest holderhas 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 and that I have the,legal right to sell this manufactured structure. Seller/current owner name(print) 1 : er/cur r,nt owner signature: Date: I release my interest in this structure. • CLAYTON HOMES ALBANY, OR Phone.(541)967-8555 I0 7,x+7 I aclmowledge this sale/change of ownership, Email: • I1 I �YG but do not release my interest in the structure. Seller/current owner name(print) Seller/current owner signature: Date: 0 I release my interest in this structure:, ,. Phone: El I acknowledge this sale/change of ownership, Email: • but do not release my interest in the structure. Seller/current owner name(print) Seller/current owner signature: Date: ❑I release my interest in this structure. Phone: 0 I acknowledge this sale/change of ownership, Email: 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: E I acknowledge this sale/change of ownership, Email: but do not release my interest in the structure. SECURITY.INTEREST HOLDER ALREADY ON RECORD (if applicable) Security holder's name(print) Security holder's signature: Date: El I release my interest in this structure. Vanderbilt Mortgage&Finance, 0 I acknowledge this sale/change of ownership, Inc. but do not release my interest in the structure. Security,holder's name(print) Security holder's signature: Date: 0 I release my interest in this structure. • • ❑I acknowledge this sale/change of ownership, but do not release my interest in the structure. PRIOR TO SUBMITTING, CHECK THE FOLLOWING: 0 Signatures from all applicable parties must be complete(current owners/sellers,new owners/buyers,and security interest 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 and OAR 918 and posted at www.oregon.gov/bcd. 0 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 0 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). If signing by Power of Attorney,submit a Change Affidavit(Form 5221). If this application is being submitted bythe seller,you must also submit int a bill of sale. 440-2952(7/19/COM) OR Title Application-10/2019-TitleAppl 1211 Page 5 004481455-00001