356060 - Laserfiche WebLink

Home Browse Search

• • 1293463 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 1 have the legal right to sell this manufactured structure. Seller/current owner name(print) Seller/current owner signature: Date: ❑1 release my interest in this structure. CLAYTON HOMES ALBANY,OR Phone:(541)967-8555 ;)."`,1 C i]I acknowledge this sale/change of ownership, Email: ��:"K tl�i ' ; but do not release my interest in the structure. � � 1'I"c . :�CL'••t'�.'_�.�1'" i •�-�:> �J Seller/current owner name(print) Seller/current owner signature: Date: ❑I release my interest in this structure. Phone: [l 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: E 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 salt/change of ownership, Email: • but do not release my interest in the structure. . SECURITY INTEREST HOLDER ALREADY ON RECORD(if applicable) Security holder's name(print) Security holder's signature: Date: ❑r 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: 0 I release my interest in this structure. E I acknowledge this sale/change of ownership, but do not release my interest in the structure. PRIOR TO SUBMITTING, CHECK THE FOLLOWING: 0 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. 0 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 0 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(7/17/COM) OR Title Application-12/2017-TitleApp11211 Page 5 004073768-00002