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i further certify that each lessor, mortgagee, trust-deed beneficiary, lien holder of record, and security-inte>}est 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: Q I release my interest in this structure.; CASCADE FACTORY Phone• (503)981-5314 ❑ I acknowledge this saleichange of ownershir, Email: CASCADEHOMES@Y/ + but do not release my Interest in the sttuctun. Seller/current owner name(print): Seller/current owner signature: Date: ❑ I release my interest in this structure.; Phone: • ❑ l acknowledge this salelchange of ownership, but do not release my interest in the titnictura. Email: Seller/current owner name(print): Seller/current owner signature: Date: ❑ I release my interest in this structure] Phone: 1-7I acknowledge this sale/change of ownership, but do not release my interest in the 4tructur;. Email: Seller:/current owner name(print): Seller/current owner signature: Date: ❑ I release my interest in this structure! Phone ❑ I acknowledge this saleichange of ovtner hip, but do not release my interest in the ltmctur Email: SECURITY INTEREST HOLDER ALREADY ON RECORD(if applicable) • Security holder's name(print): Security holder's signature: Date: [] I release my interest in this structure; ❑ I acknowledge this sale/change of ownershir, but do not release my interest in the ftructur,. • Security holder's name(print): Security holder's signature: Date: 0 I release my interest in this structure: ❑ I acknowledge this sale/change of ownership, but do not release my intetect in the gtructure. PRIOR TO SUBMITTING, CHECK THE FOLLOWING: ❑ Signatures from all applicable parties must be complete(current owners/sellers,new owners/buyers,and secur!ty 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. 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). • • ❑ If this application is being submitted by the seller, you must also submit a bill of sale. • • • • • 440-2052(7/17/COM) Page 5 . •