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DocuSign Envelope ID:A98832F6-AE52-47AF-852x;,. 4EB65F6AA 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: Q I release my interest in this structure. Factory Expo Homes ,-oocuSigned by: Phone:971-267-5024 � �?�lc+lLi�a+, 11/12/2019 1 but do notr ege es lleasemyl interest ownership, the structure. Email: cmulligan@factoryexpoln `--tNab(.ai ibLug4zu... Seller/current owner name(print): Seller/current owner signature: Date: ❑ I release my interest in this structure. Phone: ❑ I acknowledge this sale/change of ownership, 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: ❑ I acknowledge this sale/change of ownership, 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: • ❑ I acknowledge this sale/change of ownership, but do not release my interest in the structure. Em ailrr; t.r. " g '� `ite[am y w �4�f �. r �' A_ . Security holder's name(print): Security holder's signature: Date: ❑ I release my interest in this structure. El 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: 1=1I release my interest in this structure. ❑ 1 acknowledge this sale/change of ownership, but do not release my interest in the structure. g'` N ., ,,x s�yjj).,•'r- .- " ?' +' 'a ;x s ,Tt4'�,v .fig x. r +xr'a1 -k �'�.. .. Qi,'ss Y, s.�+P r�) r jog Atteet f ``�'t t -Awfvo,Lov e' t FJ�' �� Gb. ' �sJ 4� is x �'E 9 sw'f '+' ,' ® 6-.9a +`,y`, hi f a j- 4 k, f�R•Py,+... ,s ,�.'.,.`• .. '�. �... .,% ��+ �,�. .�". �iF"�'�.'�' <n�.d�•;�+..�F '�5...._a.l.G";.c I r,.aw,,..s., .}d`.3"`/�„'t. v. 5�.h�4.;L.F ESignatures 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 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(7/17/COM) Page 5