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j • <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 T have the legal right to sell this manufactured structure. <br /> Seller/current owner name(print): Seller/current owner signature: Date: I release my interest in this structure. <br /> 01 RE.5evt2.5 cm-Y) I acknowledge this sale/change of ownership, <br /> Email �O� 93,(ID f }n � ��r J ❑ but do not release my interact 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 /> 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 /> 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%hange ofownership, <br /> but do not release my interest in the structure. <br /> Email: <br /> SECURITY INTEREST HOLDER ALREADY ON RECORD Of applicable) • <br /> Security holder's name(print): Security holder's signature: Date: ❑ I release my interest in this structure. <br /> ❑ <br /> l acknowledge this sale/change of ownership, <br /> hut 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 /> ❑ <br /> I acknowledge this salefehange of ownership, <br /> but do not release my interest in the structure. <br /> • • <br /> PRIOR TO.,SUBMiTTING, CHECK THE FOLLOWING:: • <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 botb: <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 /> • <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 /> • <br /> 440-2952 t7i17/conal Page 5 • <br />