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<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: 0 I release my interest in this structure.
<br /> J & M Homes, LLC
<br /> Phone: 503-908-8166 ❑ I acknowledge this sale/change of ownership,
<br /> Email: dcallahan@jandmhome� 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: j ❑ 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 /> •
<br /> Phone: ❑ I acknowledge this sale/change of ownership,
<br /> Email but do not release my interest in the structure.
<br /> INTEREST'� •
<br /> HOLD�ER�ALREADY ON.,RECORD?(if{appl,cab'le)'� ,� � z
<br /> •�a,,. _..-.d.. ,wf.u;-•�.Ir,;.._,. =,,.dUr. a,r. rue r .>L..�'.� s i, � a`�,•y
<br /> _. ..... _ ., s v-...sem"._ +...,,, ...,,, :. _,.C€...r. a i.._... .m. +s.,.;:,,tz�...� :✓. .,.�:" _
<br /> Security holder's signature: Date: 111I release my interest in this structure.
<br /> Security holder's name(print):
<br /> ❑ 1 acknowledge this sale/change of ownership,
<br /> but do not release my interest in the structure.
<br /> Securityholder's name Security holder's signature: Date: ❑ I release my interest in this structure.
<br /> (print):
<br /> ❑ I acknowledge this sale/change of ownership,
<br /> but do not release my interest in the structure
<br /> • rSP
<br /> ,PRIOR'TOIESUBMITTING,xCHECK THEIFOLLOVIIING F rt t , p
<br /> ❑ Signatures from all'applicable parties must be complete(current owners/sellers,new owners/buyers,and security
<br /> interest holders).
<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 /> ❑ 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 applicatior?.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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