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1326001 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/currept owner signature: Date: [J I release my interest in this structure. CLAYTON HOMES ALBANY, �` 1 j OR lin / y Phone:(541)967-8555 \ ! / []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: EI I release my interest in this structure. Phone: 0 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: ❑Irelease my interest in this structure. Phone: El 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: El I release my interest in this structure. Phone: E I acknowledge this sale/change of ownership, Email: but do not release my interest in the structure. 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. []I ackmowicdge this sale/change of ownership, but do not release my.interest in the structure_ Security holder's name(print) Security holder's signature: Date: E]I release my interest in this structure. 1 acknowledge this sale/cbange 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 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) 0 If signing by Power of Attorney,submit a Change-Affidavit(Form 5221). E If this application is being submitted by the seller,you must also submit a bill of sale. • 440-2952(7/17/COM) OR Title Application-10/2018-TitleAppl 1211 Page 5 004152393-00001