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DtlauSign Envelope ID:6288A8A9-9556-4046 ‘)-3195DED5F1 E2 1449988 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 actured structure. Seller/current owner name(print) Sailer/current owner signature: Date: IV release my interest in this ahudtae. CLAYTON HOMES ALBANY, OR nucosionee cy: Phone: 54196'1-BSSS 4 Email; ( ) ,J� f` V this sale/change et ownership, I1/4/2022 � ocknowibut do not D,e�j�interest in the . Seller/current owner name(print liillgiiifififint owner signature: Date: ❑1 release tar interest ia this structure. Phone: ❑1 admmvledge this mirk:hangs of off. Email: but do not Woo my intent in the structure Seller/current owner name(print) Seller/current owner signature: Date: ❑'Meese my Witted in this slmcdme. Phone: Email: • but releaacimorledge se min b structnre Seger/current owner name(print) Seller/current owner signature: Date: ❑1 tnleese my interest in this structure. Phone: 01 arimendedge this wale/change ofot , Email. but do not release uy interest m the structure SECURITY-INTEREST HOLDER ALREADY ON RECORD(If applicable) Security holder's name(print) Security holder's signature: Date: Q!release wintered in this simetmo. Vanderbilt Mortgage&Finance, ❑1 acknowledge this seidcba nge of o wsenhip. IInc, but do not release my intnest in the structure., Secarity holder's name(print) Security holder's signature: ' Date: ❑1 idmse ay i erat in this structure. ❑1 this tsld of foown hi, but do not release my interest in structure PRIOR TO SUBMITTING,,CHECK THE FOLLOWING: 1Signaatures tt H from all applicable parties must be complete(current owners/sellers,new owners/buyers,and security 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. []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. t]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 ❑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). 0 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-ThleApp11211 Page 5 004526969-00006