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• • • • REEL 4244 PAGE 25 /� f MARION COUNTY After recording return to: r Z-c l)t''i A 1 T5vt z r BILL BURGESS,COUNTY CLERK ./ /�C. /3 i x /o S 09-20-2019 08:47 am. Y _S,/U2"-r--(o— , 0th' 973 ry / Control Number 568983 $ 91.00 Instrument 2019 00044563 Send all future tax bills to: 5 Cs As--,4.___ _ • APPLICATION TO REMOVE MANUFACTURED HOME FROM . COUNTY DEED RECORDS YEAR MAKE HUD NUMBER VIN/SERIAL NUMBER WIDTH LENGTH '1992 Berkshire ORFLN48AB1442OBS 27 66.5 HOME ID NUMBER RECORDERS DOCUMENT NUMBER MAP&TAX LOT NUMBER reel 1664,page 378 071 E07A 01302 LEGAL DESCRIPTION: . 1 Please list the legal description of the land upon which the structure is located in the space below.This may either be a copy of the deed ora description of the property as recorded in the county deed records:(Attach additional sheets, if needed) Parcel 3,Partition Plat No.94-133,as recorded November 8,1994 in reel 1204,page 363,Microfilm Records Marion County,Oregon If there is a secured interest in the property(land and manufactured structure),list the names and addresses of all security interest holders,mortgagees,trust deed beneficiaries,or lien holders of record holding any interest in the land and manufactured structure in the spaces below.All secured parties must sign and approve this form.If there are more than two secured parties,provide the names and addresses and approval signatures on a separate sheet of paper and attach to this form.If there are none,write"none". **1/We certify that the statements made on this application are true to the best of Iny/our knowledge.All mortgagees,trust deed beneficiaries,lien holders of record and security interest holders are listed,or if there are none,I have certified this by writing"none"in the space provided. OWNER INFORMATION: it �/ /) {�) A r! 0.1-4 y//+,[/j 1 kyr (/ PR�4--6„,e_..F(', J) ity- l�,7cti`l Lyto A-1 t/H,b� ' �0. ' 1'eei- i tM. flJa,v '`--“I• fY,r '. ' SIGNA 1.RROFOWN ( I SITUS Ana ES`,S' /�/ /y) �) `// l SIGNA ....- n 37 rd ✓fQT-7/C/'r�Vr./�F 5/ fol Or PULLING ADDRESS / i 973 / 7 -Z�Mfes= /6e4 , ii/vYTdD; SECURED PARTY ORMATION: \Ctrl I .� A 41Q-✓t .j-{s5 { j;�..L _ / 1 I �j / NAME OF SECURED PARTY N n _ © 1 V ADDRESS OF SECURED PARTY - • SIGNATUReJAPPROYAL OF SECURED PARTY* • *Owner and Secured party signatures must be notarized.Attach additional sheets if necessary. NOTARY: State of Oregon County of ,y'Yfl.-. • T e for going instrument was ac ow�le��ged blefor e this_ 1day of 20 by �UAllt'� (ta, . • Ad'? �” ,P ^,a %, OFFICIAL STAMP Signature of Notary Pubife �� '-1/4 �0LY BETH HATFIELD My commission expires: 1 Z �7(w • ', ^ !j' RCOMMISSION NO.957074A MYCOWast10Ndins DECEMBER 13.2020 NOTARY: ' State of Oregon County of (/1" AND-1v Th reg ing instrument was acknpwledgpd bef�f99regi.ch-i ?��ll day of _ • 2011 by `"lti( ti j-4. -!keP 4' __. _ OFFICIAL STAMP Ut MOLLY BETH HATFIELD Signature of Notary Public(-1/1A4_, ,y k, (-7-- NOTARY PUBLIC-OREGON COMMISSION NO.957074A .z !ilk +t fi01� 13,2021) My commission expires: ((J1`( _ _.__- ._..__- rr DEPARTM.NT KF This certification is being submitted for recording to the county clerk for the county in which the real property is located. ,R.,BUSINF S A copy of said recorded document is being provided to the State of Oregon Building Codes Division or one of county SERVICES agents,along with the County Manufactured Home Notification and Tax Certification Form for Used Homes and a ' 440-5175(1/17/COM) Manufactured Home Bill of Sale/Change Application. • 1