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DocuSign Envelope ID:81338090D-DAE9-4ACB-A452-59AA00150A2E 1448441 I further certify that each lessor,mortgagee, trust-deed-beneficiary,:lieil:_holder of record, and.security-interest holder 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 and that I have the legal right to sell this irianufaotured structure. 'Seller/current owner name(print) Seller/ t owner signature: Date: WA release-any interest in this stratum. CLAYTON HOMES ALBANY, /'" OR i� Phone:(541)967-855S� �, ` I a z7 rl 1 acknowka ethis sale/change of ownership, 7U^ rt but do not release my interest in the structure. Seller/current owner name(print) Siler/current owner gnature: Date: 0 I release my interest in this structure. Phone: Email: 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: Q I release my interest in this structure. Phoail: 0I acknowledge this sale/change of ownership, but do not release my interest in the snuctur.� Seller/current owner name(print) Seller/current owner signature: Date: ❑I release my interest in this structure. Phone: Email: acknowledge this sale/change of ownership, 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: Q I release my interest in this structure. Vanderbilt Mortgage&1[tinance, Q 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: ❑I release my interest in this structure. 0 I acknowledge this sale/change of ownership, but do not release my interest in the structure PRIOR TO SUBMITTING,CHECK THE FOLLOWING: ❑Signatures from all applicable parties must be complete(current owners/sellers,new owners/buyers,and security interest holders). ❑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. ❑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. ❑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 i❑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 by the seller,you must also submit a bill of sale. 440-2952(7/19/COM) OR Title Application-10/2019-TitleApp11211 Page 5 004499938-00002