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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 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 owne signature: Date: ❑® I release my interest in this structure. NWHOMEBUYERS.NET,LLC ( �s/— IM (811'411 b I acknowledge Ibis sale/change of ownership, Phone: 503-762-1915 r 6 ll ❑ but do not release my interest in the structure. Email: nwhomebuyers@msn.cgy 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 my interest in the structure. Email: 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 my interest in the structure. Email: Seller:/current owner name(print): Seller/current owner signature: Date: ❑ I release my interest in this stmcture. I acknowledge this saleichange of ownership, Phone: ❑ but do not release my interest in the structure. Email: gN SECURY INJ -n4 04, NECOD(f appheable} 3. ` s Security holder's name(grin!): Security holder's signature: Date: ❑ I release my interest in this structure. ❑ 1 acknowledge this sahhemership, but do not release my leinterestngei in theo1'osstructure. Security holder's signature: Date: 111I release my interest in this structure Security holder's name(print): . ❑ I acknowledsaldcbange of own , but do not relgeeasethis my interest in the structure.ership y n,*tr PRlORtTO SUBMITTIi1G,CHECK THE FOLLOWING Y ,' ❑ Signatures from all applicable parties must be complete(current owners/sellers,new owners/buyers,and security interest holders). ❑ A valid tax certification front 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 wwvv.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. • 440-2952(7/I 7/COM) Page 5