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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: Q I release my interest in this structure. HOMES DIRECT OF OR 01/02/2020 ❑ I acknowsale/change of ownership, Phone: 541-928-2083 but do not releaseledgethis my interest in the structure. Email: neilaw31@gmail.com ❑ Seller/current owner name(print): Selle /current Ener signature: Date: I release my interest in this structure. ❑ I acknowledge this sale/change of ownership, Phone: but do not release my interest in the structure. Entail: Seller/current owner name(print): Seller/current owner signature: Date: 0 release my interest in this structure. ❑ I acknowledge this sale/change or ownership, Phone: but do not release my interest in the structure. Email: ❑ Seller:/current owner name(print): Seller/current owner signature: Date: I release my interest in this structure. ❑ I acknowledge this sale/change ofownership, Phone: but do not release my interest in the structure. Email: h ( Security holder's signature: Date: I release my interest in this structure Security holder's name(print): I-1I acknowledge this sale/change ofownership, but deo not release my interest in the structure. Security holder's signature: Date: ❑ I release my interest in this structure. Security holder's name(print): ❑ I acknowledge this sale/change of ownership, but do not release in,interest in the structure. ,,a � r0 4, ®� � 1 � p j, A`` .9s �lr ,# 5 i *tg' r1 , 'v . a Signatures from all applicable parties must be complete(current owners/sellers,new owners/buyers,and security (--1 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(7/17/COM) Page 5