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DocuSign Envelope ID:D92A96DD-4956-4999-A5B7-F98DBB19D7E7
<br /> 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: Li I release my interest in this structure.
<br /> FACTORY EXPO HOMES DoeuSfgned by:
<br /> Phone:971-267-5024 �e,tirvw yyl,-//_r,„ 3/11/2020 I 1E39IInf gethissale/changeofownership,
<br /> Email: cmulligan@faetoryexpote
<br /> l '"""'� but o not release my interest in the structure.
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<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 /> Phone: _ ❑ I acknowledge this sale/change of ownership,
<br /> Email: but do not release my interest in the structure.
<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 /> Email: but do not release my interest in th&structure.
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<br /> Security holder's name(print): Security holder's signature: Date: 1: 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): Security holder's signature: Date: LII release my interest in this structure.
<br /> ❑
<br /> I acknowledge this sale/change of ownership,
<br /> but do not release m7 interest in the structure.
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<br /> ❑
<br /> Signatures from all applicable parties must be complete(current owners/sellers,new owners/buyers,and security
<br /> interest holders).
<br /> ❑
<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 /> ❑
<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/bcd.
<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 /> ❑ 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 /> 440-2952(7/17/COM) Page 5
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