126223 - Laserfiche WebLink

Home Browse Search

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: J g I release my interest in this structure. Phone: a — 1( S C%f %i it- 1` 9 ❑ I acknowledge this sale/change of ownership, 6 but do not release my interest in the structure. Email: O l.�vS e 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. Email: SECURITY-INTEREST HOLDER ALREADY ON RECORD (if applicable) Security holder's name(print): Security holder's signature: Date: 0 I release my interest in this structure. J ill ❑ I acknowledge this sale/change of ownership, (UIY but do not release my interest in the structure. Security holder's name(print) Security holder's signature: Date: ❑ I release my interest in this structure. ❑ I acknowledge this sale/change of ownership, but do not release my interest in the structure. PRIOR TO SUBMITTING, CHECK THE FOLLOWING: ❑ 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 bo h: • ❑ (A)the county the home is moving from and YI P02—t O4V GO . Tr( 503.5+� -�jl'-� 055 GIBS i S (B)the county the home will be moved to "rl l,(Jkwlptc!,., (� i , �YJ3,p L4-2,3400 ❑ 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). 0 If this application is being submitted by the seller,you must also submit a bill of sale. • 440-2952(7/19/COM) Page 5