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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: 0 I release my interest in this structure, Alta Cima Corp.Phone: � �� ha�1 ❑12�05/2022 I acknowledge this sale/change of ownership, Email: /�y but do not release my interest in the structure, Seller/current owner name(print): Seller/current owner signature: Date: ❑ I release my interest in this structure. Phone: T acknowledge this sale/change of ownership, Email: but do not release my interest in the structure. 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, Email: ❑ but do not release my interest in the structure. 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, Email: ❑ but do not release tuy interest in the structure. e'rtFR��.xw�ry�l<5�{t�i}rr`f�T3�+,. '4 ;.„IeGs;,.'�nrA-arc�:'�-r,!' dyr" Eby� { 7�.a�fYA S44i .Js'Y�44 5 t StT f•:Lr 7r..t]rz✓try f .i a�7v i...{.�.r .,�:., y cr3 i, �l7t,r,'fggd hl f1�iPfi 'f'iatgfi L12Ei41�Y O„�V EtEGURD,(�f�ap ltchbI�11s 9)-C , , L ?%L � �� p / Y' - Y ll�:. ♦ ./ ,t �}n Security holder's signature: Date: ❑ I release my interest in this structure, Security holder's name(print): ❑ i acknowledge this sale/change afownership, but do not release my interest in the structure._ Security holder's name(prier): Security holder's signature: Date: ❑ i release my interest in this structure. I acknowledge this sale changen th or owncrsiiip, v e F 1 s� { ., ;se+. .+ ❑ but do not release my interest ie structure. r�i5r'_.s..�_�.i ar.:�i.,Sll}�w{)3f*t'a36 ti�sS'�ifijir,lr,�ilt'� �..;_ .i' JL11YI� �i'V�tJ'7 G\7►�,l l HEV� L�� ■YINGi i .4 tr i .. / n { ❑ 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 both: ❑ (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 (Form 5176 or 5175 found at www.oregon.gov/bcd). ❑ If signing by Power of Attorney,submit a Change Affidavit(Form 5221). ❑ if this application is being submitted by the seller,you must also submit a bill of sale. • 440-2952(7/19/COM) Page 5