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DocuSign Envelope ID:018B707E-E036-49C9- -DC6AA244DAF6
<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 /> •
<br /> Seller/current owner name(print): Seller/current owner signature: Date: Q I release my interest in this structure.
<br /> Factory Expo Homes
<br /> Phone:971-267-5024 vwDoouSlgned by:
<br /> �� I acknowledge this sale/change of ownership,
<br /> tiown is
<br /> Email:cmulligan@factoryexpoha
<br /> th 19/2020 I 91:.:L5 t c1M0 release my interest in the structure.
<br /> Seller/current owner name(print): Seller/curren --77411@fr9igffiteti'e: 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 the structure,
<br /> Seller:/current owner name.(print): Seller/current owner signature: Date: ❑ I release my interest in this structure.
<br /> Phone: " 1 acknowledge this sale/change of ownership,
<br /> but do not release my interest in the structure.
<br /> Email:
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<br /> Security holder's name(print): 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): Security holder's signature: Date: ❑ I release my interest in this structure.
<br /> ❑ I acknowledge this sale/change of ownership,
<br /> �.�������x�xx'�r'wr��t^�i?3��,�� � «c.�,��L .� ay+� ��,:,�-� lr haz,� ,x• ..� but do not release my interest in the structure.,
<br /> z ���`"�.� �`�-4 � ,��,r� a�"` � ���'� ,�'��-ks��s� �,� �'��r«,`��i��•�iu"r�.�,�" � ,�a 2 , ,r nom" y
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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 /> ri❑ 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/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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