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• 1 • I further certify that each lessor, mortgagee, trust-deed beneficiary, lien holder of record, and security-interes' holder has been listed on this notice, or if none are listed, that this structure is free and clear of all mortgages I 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/c rent owner signature: Date: 0 I release my interest in this structure. 1 CASCADE FACTORY ! Phone: (503) 981-5314 i � ❑ Ibuack nnowledge this sale/change of ownersfhip, I do not release my interest in the stntlure. Email. CASCADEHOMES a@YNI Seller/current owner name(print): Seller current owner signature: Date: ❑ I release my interest in this structure. i Phone: ❑ w I acknowledge this sale/change of one�sltip, hut 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 Phone: ❑ 1 acknowledge this sale/change of ownership. • but do not release my interest in the strubture. Email: Seller:/current owner name(print): Seller/current owner signature: Date: ❑ (release my interest in this structure. 1 ! Phone ❑ I acknowledge this sale/change of ownership, but do not release my interest in the stntc-ttre. 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. F ❑ I acknowledge this sale/change of owuel$hip, but do not release my interest in the structure. Security holder's signature: Date: ElI i release my interest in this structure. Security holder's name(print): • 0I acknowledge this sale/change of ownehip, 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 securit)) ❑ 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. lithe 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 j ❑ 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). •I ❑ If this application is being submitted by the seller, you must also submit a bill of sale. • 1f 440-2952(7.'17/CO ) Page 5 {