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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 tY
<br /> �sectiri � his structure is free and clear of all mortgages,
<br /> deeds of taus
<br /> tr ty.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:
<br /> /#:i,;. CI* QAC release my interest in this structure.
<br /> Comp
<br /> Phone: �'. • ' Q
<br /> Email: . ? 7 /; B
<br /> G�CJ I acknowledge this sale/change of ownership,
<br /> but do not release my interest in the structure,
<br /> Seller/current owner name(print): Seller/current owner signature: Date: [l I release my interest in this structure.
<br /> Phone:
<br /> Email: . ❑ 1 acknowledge this sale/change of ownership,
<br /> but do not release my interest in the structure.
<br /> Seller/current owner name(print): Seller/current owner signature: Date: El I release my interest in this structure.
<br /> •
<br /> Phone:
<br /> El I acknowledge this sale/change of ownership,
<br /> Email: but do not release my interest in the structure.
<br /> Seller:/currentowner name(print): Seller/current owner signature: Date:
<br /> ElI release my interest in this structure.
<br /> Phone:
<br /> Email.
<br /> I acknowledge this sale/change of ownership,
<br /> t gg � g y�} +� G but do not release my interest in the structure.
<br /> . , �iCJ rt9 I Id} ti`'7'n Arg fi 15• l �{w r ar, 4 4a'§�. 4`' '' YFus•�k?�tw 5z-�a+r' er•r;, *-^ v;'.,X
<br /> fy �tr•. 9 � ;yk� 1 !u I ggg ri� )6'yy e�}i h��1;;
<br /> ::f d.:..:.:Y.,, . .. . s (mSl�4n,1 .1P a 1�Il4%(,24 j J1 C ogoat Y�'� i@'' 4f 'i1� `y�'.a� �'�6%,',1
<br /> tT k g
<br /> r ^h�• .Ar•'. 1.,.:, �..f_ ? ?.ie? .,.._ : w :4".' ,y f'�`;!
<br /> Security holder's.name(prrni):'.' Security holder's signature: Date: ❑ I release myinterest in this structure:
<br /> a ' '' I acknowledge this sale/change of ownership,
<br /> but do not release m interest in the structure.
<br /> Security holder's name(pring: 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 m interest in the structure.
<br /> �t t • t n'+ 'A-' fr j; '#ai�'S. �j} .r1.99 i n r#}t r-r+.x+-r li,3 r�{�i i.,-rs �9 a 1 �,3/0 s .0;7C'.'r.-iii n^:'R
<br /> t . . , .�`t� ,,:.,Y`� &j F^.�y F.3.r t? 1,;r1.af7tl),'4,1(J ImtYd.!`�t 4�ge .d63HW Y' fF .4Yy'( Yl�o-�''t c$„,1 •Z'�.�t�YL* �l 'a 1'!4''+x i,.. x t� .,^.4
<br /> ' .; ... �.,.'.� rZn5�x ,.....,.�.;f3T x..�'���et:"yh^rtl��`9'^5� �-�t'��il?y?14kWv{ij'pR"�ir�Xr 'W�at'' {�?t �. K�yf�r)�
<br /> ❑ Signaturesfrom all applicable parties must be complete(current owners/sellers,new owners/buyers,and security
<br /> interest holders).
<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 bya-county official.
<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 /> El 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 /> 440-2952(7/17/COM) • • • Page 5
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