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1496272 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 signature: Date: ED I release my interest in this structure. CLAYTON HOMES ALBANY, OR Phone:(541)967-8555 \T„ I acknowledge this sale/change of ownership, Email: but do not release my interest in the structure. Seller/current owner name(print) Seller/ u rent owner signature: Date: []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: ED I release my interest in this structure. Phone: Email: E3 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: - ❑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. 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, 13 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. -- D I acknowledge this sale/change of ownership, but do not release my interest in the structure. PRIOR TO SUBMITTING, CHECK THE FOLLOWING: Ei 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, ID Any additional documents needed to establish your authority to buy/sell this home as required by ORS 446 and OAR 9I8 and posted at www.oregon.gov/bcd. El]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 E]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-TitleAppl 1211 Page 5 004664330-00004