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• <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): Seller/current owner signature: Date: 0 I release my interest in this structure. <br /> J&M Homes, LLC <br /> Phone: 503-908-8166 ❑ I acknowledge this sale/change of ownership, <br /> but do not release my interest in the structure. <br /> Email: tmeichior@jandmhomesd <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 /> 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: 111I release my interest in this structure. <br /> ❑ <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 /> ❑ <br /> Signatures from all applicable parties must be complete(current owners/sellers,new owners/buyers,and security <br /> interest holders). <br /> ❑ <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 /> ❑ <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 />