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• • I REEL 4258 PAGE 119 <br /> MARION COUNTY <br /> After recordipg return to: ( _ ,, 0 L- A.(Le— BILL BURGESS, COUNTY CLERK <br /> / q0e eS I �e i Control N umber 573633 10-22-2019 11:54 am$ 96.00 <br /> v Instrument 2019 00051657 <br /> Send all future tax bills to: . <br /> - 0c � . <br /> APPLICATION TO REMOVE <br /> MANUFACTURED HOME FROM <br /> COUNTY DEED RECORDS <br /> YEAR MAKE HUD NUMBER VIN/SERIAL NUMBER WIDTH LENGTH <br /> • 1985 Fleetwood WAFL2ABF16315971 LJg t (PO f <br /> HOME ID NUMBERRECORDERS DOCUMENT NUMBER MAP&TAX LOT NUMBER <br /> N I A Reel 2337 Page 44 CA-2W 2.61 De o 1 Ono <br /> LEGAL DESCRIPTION: <br /> 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 or a description of the <br /> property as recorded in the county deed records:(Attach additional sheets, if needed)' <br /> I-crt 3 iI©UI- 13, r ol.Jna or TuR&)ti&1 ivl 410_ e,41.1 of i hrztier-; C:aLAy r)C kietnal <br /> 54•29,-(.e a-('0 rtZ9r,,,-, <br /> 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 <br /> 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 <br /> 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 <br /> there are none,write"none". <br /> **I/We certify that the statements made on this application are true to the best of my/our knowledge.All mortgagees,trust deed beneficiaries,lien holders of <br /> record and security interest holders are listed,or if there are none,I have certified this by writing"none"in the space provided. • <br /> OWNER INFORMATION: <br /> PRINTED NAME OF OWNER(S) . <br /> Donald Brinlee and Mildred L Brinlee Trust, Mildred L Brinlee Trustee <br /> SIGNATURE OF OWNER•" • SITUS ADDRESS <br /> . X9-'-0 7 7a '' To, A* . ,/,/,.......„...,..,,r.�.,, OA , <br /> E OF OWNER". � MAILING ADDRESS S+C. <br /> SY o tL3A. }L9. R,J1. F�3 p' <br /> SECURED PARTY INFORMATION: /On <br /> NAME OF SECURED PARTY • 9 <br /> 730L <br /> Aka" P. f3^i a <br /> ADDRESS OF SECURED PARTY + <br /> SIiNATURElAPPROV FSE U '�TY"� •ozi I Ca 152 2 • <br /> Sem 44C- 1 ) ' <br /> *Owner and Secured party signatures must be notarized.Attach additional sheets if necessary. ' . <br /> NOTARY: <br /> State of Oregon County of wt/1 dh <br /> ' � OFFICIAL STAMP <br /> The foregoing instrument was acknowledge l before me this i )�day of aS.„;`• JAMES H SKINNER <br /> Jx 4.c„„G-rr ,20 by ;I L. evil' 1- - , m. NOTARY PUBLIC-OREGON <br /> 11 �.•,-x� COMMISSION NO.989153 <br /> MY COMMISSION EXPIRES JUNE 30,2023 <br /> Signature of Notary Public„icm/h. - <br /> My commission expires:6 30- 23 • . <br /> • <br /> r DEPART ENT OF This certification is being submitted for recording to the county clerk for the county in which the real property is located. <br /> CC)NUMER •A copy of said recorded document is being provided to the State of Oregon Building Codes Division or one of its county <br /> LISINEES <br /> agents,alongwith the CountyManufactured Home Notification and Tax Certification•Form for Used Homes and a <br /> I-- <br /> IPSS <br /> .�SERVICES g <br /> 440-5175(1/17/COM) Manufactured Home Bill of Sale/Change Application. <br /> 1 <br />