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DocuSign Envelope ID:9B4E1DAC-5DC4-4076-A3DA-D66E27A19A1F 1481727 • I further certify that each lessor,mortgagee,trust-deed beneficiary,lien 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 manufactured structure. Seller/current owner name(print) Seller/current owner eignature: Date: 0 heleasemyInt e t in this structure. CLAYTON HOMES ALBANY, • OR • EEmail:(541)9674555 l J4D _ Seller/current owner name(print) Seller/ owner signatures Date: 0 I release my Edgiest inj,agu e, Phone: Email: ❑ this sale/change efownaship. releasebut do not my interest in the structure. Seller/current owner name(print) Seiler/current owner signature: Date: ❑Indere.my interest in this structure. Phone:• s0 1 aclatowledge thle satercbange of on/naabip, but do not mime my interest in the structure. Seller/currentowner name(print) Seller/current owner signature: Date: 0 Intense myinterest inthis immure. Phone: Email: ❑I acknowledge this,ate%Lange ofownembip Vat domotnrleasemyinterest inthestiric4uo. SECURITY44NTEREST HOLDER ALREADY ON RECORD(if applicable) Security holder's name(print) Security holder's signature: Date: ❑1 release my interest in thin structure. Vanderbilt Mortgage&Finance, 01 acknowledgemi,sale! dip, Inc. but elorot teeasemyinterest in the structure. Security holder's name(print) Securityholder's tdgnatllr'e: Date: [p release my interest in this Structure. ❑I acknowledge this seldrhaage ofowsership, but donotrelease my interest m the striietrue. PRIOR TO SUBMITTING,CHECK THE FOLLOWING. ❑Signatures all applicable parties must be complete(current owners/sellers,new owners/buyers,and interest holders). security 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. Q 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 cotmty 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 byPower of Attorney,submit a Change Affidavit(Form 5221). []If this application is being submitted by the seller,you must also submit a ball of sale. 440-2952(7/19/C0M) • OR Title Apphcation-10/2019-15tleApp11211 Page 5 004589979-00001