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<br /> Rdque.sf'ed By:529900 03/10/2023 .
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<br /> f l IrW.V.T.�APPLICATION TO EXEMPT MOBILE HOME FROM
<br /> ii�� REGISTRATION AND TITLING REEL. PAGE
<br /> Owner's Certificate of Legal Interest B 61 262
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<br /> INSTRUCTIONS:
<br /> This loft must be completed;signed by all Interest holding parties and must have a title search or Lot Book Report attached.The title search or
<br /> 7.
<br /> Lot Book Report cannot be over 7 days old when submitted to the Motor Vehicles Division.
<br /> Thle'form and-title search or Lot Book Report must be submitted with your mobile home title documents and,If the mobile home Is to be
<br /> financed,proof of a loan approval.
<br /> h �., ._.. PART
<br /> I)WE the undersigned hereby_certify that f/WE am/are the owners)of record of real property,the legal description end location of which le.=.
<br /> (description as-recorded by county recorder or a certified copy of your deed may be substituted):
<br /> Seey;Attached-Exhibit "A" -
<br /> ii there is a mortgage;deed of treat or.Ilen on this land filet all mortgagees and beneficiaries of deeds of trust below.Space le provided for
<br /> two names and ad dresses ._
<br /> NMEANDADOREaa" - _ _ _ ,
<br /> - - The.,Cotwncricel Bank, P. 0. Box 428, Salem, OR 97308
<br /> ' NAME'AND ADORES!'- .___- - - - -.
<br /> I Tax Lot Number(from assessor): 57327-949
<br /> :._._,.. '. _. PART II - •
<br /> • I further certify that I am also the owner of a mobile home which Is located on the real property described above and that the legal- . .
<br /> ?'.I; ,description of the mobile home is:
<br /> YEM 'LAAE YAWN LENOTN KM=IDENTIFICATION NO. _ .
<br /> 1991 ;...FLTWD"' ': • 7R F (Qpr ORFLL48A11985BS- .
<br /> If there-la a secured Interest In the mobile home list all security Interest holders,mortgagees,benefclarlea of deeds of trust,and Iienholde}J1
<br /> t whose Interest Is secured by the mobile home below.Space Is provided for two names,addresses and approvals.Signatures from the partl .
<br /> i . listed below are their approval that the application may be submitted. C:i
<br /> j NAMEANOADORERS'-
<br /> s i The Commercial--Bonk, P. 0. Box 428, Salem, 0R 97308 -m
<br /> 9 NAME AND'ADORESS. ....._- / ..
<br /> DAT6y/ .,ATUREOCSECURED PARTY _ _ DATE
<br /> • TUniOP4{FyRLPP1R>;T � 1 % "'7
<br /> Lfi ,e -rr K _•.L1.k''.t !/ `GY1�1.Wei„Q ?/ X
<br /> { Tax LoiNlimber(fiCiniisbasor): None assigned -_new unit
<br /> j I/WE.own'the and 0 and/or mobile❑described above free and clear of all mortgages,deeds of trust,security interests,and liens.
<br /> 9 i I/WE certhythat the atetomenta made above are accurate to the best of my knowledge. , -. - .. -. .
<br /> TUREOPOMNER .. _ ,. TELEPHONE IOW�W IMMATURE Or CO-0Nn7ER..-
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<br /> INDIVIDUAL ACKNOWLEDGMENT
<br /> STATE OF 1
<br /> County of / )
<br /> On this day personally appeared before me +79i1 U rSe J
<br /> to me known to be(or In Caltiornie personally known to me or proved to me on the basis of satisfactory evidence to bet the Individual,or indl•
<br /> vtduals dolt ibed in and who executed the within and foregoing Instrument,and acknowledged that s he signed the
<br /> same as oi•-A.,, free and voluntary ad end deed,for the uses and purposes therein mentioned.Given under my hand and official seal this
<br /> .73 . ayo El.. CD
<br /> BY _ ��C Residing at 5a-Ier , e e. _—.
<br /> ,Notary Public it •^a ice r slide. ;. - -^ 4--- My commission expires -.,
<br /> .. An1r:..r.. ,.).
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