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I further certify that each lessor, mortgagee,trust-deed beneficiary, lien holder of record, and security-interest
<br /> holder has been listed on this notice,or if none are listed,that this structure is free and clear of all mortgages,
<br /> deeds of trust,security interests, and liens and that I have the legal right to sell this manufactured structure.
<br /> Seller/current owner name(print): Seller/current owner signature: Date: Q I release my interest in this structure.
<br /> J&M Homes, LLC
<br /> Phone: 503-908-8166 ❑ I acknowledge this sale/change of ownership,
<br /> but do not release my interest in the structure.
<br /> Email: bbaxter@jandmhomes.cn
<br /> Seller/current owner name(print): Seller/current owner signature: Date: ❑ I release my interest in this structure.
<br /> Phone: • ❑ I acknowledge this sale/change of ownership,
<br /> but do not release my interest in the structure.
<br /> Email:
<br /> Seller/current owner name(print): Seller/current owner signature: Date: ❑ I release my interest in this structure.
<br /> 1 acknowledge this sale/change of ownership,
<br /> Phone: ❑ but do not release my interest in the structure.
<br /> Email:
<br /> Seller:/current owner name(print): Seller/current owner signature: Date: ❑ I release my interest in this structure.
<br /> El I acknowledge this sale/change of ownership,
<br /> Phone: • but do not release my interest in the structure.
<br /> Email:
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<br /> Security holder's name(print):
<br /> Security holder's signature: Date: ❑ I release my interest in this structure.
<br /> ❑
<br /> I acknowledge this sale/change of ownership,
<br /> but do not release my interest in the structure.
<br /> Security holder's name(print): .
<br /> Security holder's signature: Date: 1:1I release my interest in this structure.
<br /> ❑ I acknowledge this sale/change of ownership,
<br /> • but do not release m interest in the structure.
<br /> .,c
<br /> �+ ;�,.,s:.. �� -�.. *` 4 �rE;t,�,r�+ ,5.�%.%:t,�k ��..spci„'� v:��.:.dr4 .n�tia�v,�y. 71,�.r tizK�.t._ •'is{.�ttj `'4§s,�''�ra.,` z a.�3€c �-{'' rhrs=�5�,
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<br /> ❑ Signatures from all applicable parties must be complete(current owners/sellers,new.owners/buyers,and security
<br /> interest holders). _
<br /> ❑ A valid tax certification from the county tax assessor.The tax certification form will be provided by the county
<br /> office and must be signed by a county official.
<br /> ❑ Any additional documents needed to establish your authority to buy/sell this home as required by ORS 446
<br /> and OAR 918 and posted at www.oregon.gov/bed.
<br /> If the home is being moved to a different county,a valid tax certification form is needed from both:
<br /> ❑ (A)the county the home is moving from and
<br /> (B)the county the home will be moved to
<br /> ❑ If recording in or removing from county deed records,you must also submit a copy of the recorded
<br /> application(Form 5176 or 5175 found at www.oregon.gov/bcd)
<br /> •
<br /> ❑ If signing by Power of Attorney,submit a Change Affidavit(Form 5221).
<br /> ❑ If this application is'being submitted by the seller, you must also submit a bill of sale.
<br /> •
<br /> •
<br /> 440-2952(7/17/COM) Page 5
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