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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 owner signature: Date: ❑ 1 release my interest in this structure. J & M Homes, LLC Phone: 503-908-81661--J acknowledge this sale change of ownership, but do not release my interest in the structure. mail: bbaxter@jandmhomes.ce Seller/current owner name(print): Seller/current owner signature: Date: ❑ I release my interest in this structure. Phone: • ❑ I acknowledge this sale/change ofownership, 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. 1-1 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. Phone: ❑ ot Y. > SrS-•�M� acknowledge l ebut dorelease msale/change interestarest Hin the eSStructure.'z Email: fh '� rOi��fkf=W69th � tg." #p ya Ipat4o4 Security holder's name(print): Security holder's signature: Date: ❑ t 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(prim): Security holder's signature: Date: ❑ I release my interest in this structure. ❑ acknowledge this sale/change of ownership, but do not release my interest in the structure. gra t r 9at'rf C +y3��y'`'l+i��.- �} /n SY+`ti':`/.��`.4'�".,;rai:Ysa3:.Y`��n'a;�+r'�1;`•�rtTirF.i..� � " '� `�x� °`t� .N4i .r� ^�"y g�X'�Y.�`ti f "�?t�'Gs��.St ,C A 4�t.� .sc s., N L fl" �i�.'Parea ','meg, I1k`S4S5. ' k ,�,?�,S�i+�t t.a..�'i'?� x`.. ir: :�'t��a. � .`�-'$+ i..0 t E.1 df.'tiSt.h'i�??' 7£�'?rr .t ❑ 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. 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 wi l l 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(7/17/COM) Page 5