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• rFfidrther 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 a Zvi, (print: Seller/currant nt owner signature: Dater Fel- I release my interest in this structure. (oZ "'— i ❑ batkonwdegeeasthie smsal yient%hantgein othf oe wn struerschirep°Emai: Seller/current owner nape(print): Seller/current owner signature: Date: e I release my interest in this structure. Phone: U 4 61 � � ❑ I acknowledge this sale%hange of ownership, Email: / J� but do not release my interest in the structure. 1 Il Seller/current owner name(print): eller/c eat owner signature: Da2 : 0 I release my interest in this structure. Phone: Email: ❑ I acknowledge this sale%hange of ownership, but do not release my interest in the structure. Seller:/current owner name(print): Seller/current owner signature: Date: 0 I release my interest in this structure. Phone: ❑ I acknowledge this sale/change of ownership, Email: do not release my interest in the structure. :< mg©jRr oNtegEgT'©LO AL oOy 0R-rAgo'"okrip,Appdici 18o :. ::. Security holder's name(print). Security holder's signature: Date: 0 I 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 6,4710: Security holder's signature: Date: 0 I release my interest in this structure. ❑ I acknowledge this sale/change of ownership, . . .. '..: O�-:-�0.<�l�'/0EVEl.VItlFtL�"-Jy:CHEOK:T . but do not release my interest in the structure. P Signatures from all applicable parties must be complete(current owners/sellers,new owners/buyers,and security interest holders). 0 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: 0 (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(Foam 5176 or 5175 found at www.oregon.gov/bcd) 0 If signing by Power of Attorney, submit a Change Affidavit(Form 5221). 0 If this application is being submitted by the seller, you must also submit a bill of sale. 440-2952(7/17/COM) Page 5