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i 1272788 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: g/]I release my interest in this structure. CLAYTON HOMES ALBANY,OR Phone:(541)967-8555 f . V SZ� ❑I acknowledge this sale/change of ownership, Email: but do not release my interest in the structure. sSeller/current owner name(print) Seller/current owner signature: Date: ❑I release my interest in this structure. Phone: ❑I acknowledge this sale/change of ownership, Email: 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: ❑I acknowledge this sale/change of ownership, Email: 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: ❑I acknowledge this sale/change of ownership, Email: but do not release my interest in the structure. °'htkt3' S CUR%r�:tT1r^3�N.-+ E�R1�ES1 3�^o.e�rr: RL# AD(O »RE. Cg�� ° �iez*5r.r.fi.._,.saA• r40y tpp �d�*5 Security holder's name(print) Security holder's signature: Date: ❑I release my interest in this structure. ❑I acknowledge this sale/change of ownership, 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. ❑I acknowledge this sale/change of ownership, but do not release my interest in the structure. � 4.T ` " 070 yfiTO �16.s' Malt F-..rrfe,aeTO �6V.".iV*:_� F ", �;;;MS-V4 nikt; _s,,iA { TA w,4 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. �]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. 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 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). El If this application is being submitted by the seller,you must also submit a bill of sale. 440.2952(7/17/COM) OR Title Application-12/2017-TitleAppl 1211 Page 5 004021600-00002