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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 /> CASCADE FACTORY • <br /> Phone: (503)981-5314 ❑ I acknowledge this sale/change of ownership, <br /> but do not release my interest in the structure. <br /> Email: CASCADEHOMES@YP6 <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: 0 1 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: <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 /> SECURITY INTEREST HOLDER ALREADY ON Rtt.:VKu(it applicable) <br /> Security holder's name(print): Security holder's signature: Date: EII 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: E] 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 /> 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 /> 0 <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 /> 0 (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 therecorded <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 /> ❑ I 11111s application is ueing su• bmitted uy the Scud',you must also suumit a ullt of Sate. <br /> • <br /> • <br /> 440-2952(7/17/COM) Page 5 • <br />