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. 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 arc 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: ❑ I release my interest in this structure. I acknowledge this sale/change of ownership. Phone: ❑ but do not release tin'interest in the structure. E • mail:_ --- — --- 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. but do not release my interest in the structure. Email: ...---- Seller/current owner name(prim): Seller/current owner signature: Date: ❑ I release me interest in this structure. Phone' • ❑ Iacknowledge this rule/chaneeofownership. but do not release my interest in the structure Email: ------- Seller/current owner name(print): Seller/current owner signature: Date: ❑ I release my interest in this structure. Phone: El acknowledge this sale/change ot•ownership• but do not release me interest in the structure. Email: • f SECURITY INTEREST HOLDER ALREADY ON RECORD (if applicable) f Security holder's name(pr ins/: Security holder's signature: Date: ❑ I release my interest in this structure. ❑ I acknowledge this sale/change atm nership. but do not release my interest in the structure Security holder's name(prim/: 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. PRIOR TO SUBMITTING, CHECK THE FOLLOWING: . — ❑ 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.'File 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. —_---- lithe home is being moved to a different county, a valid tax certification form is needed from both: D (A)the county the home is moving from and (B)the county the home will he 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. • • • .11(i i,7(7/ITCOMi • Page