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• <br /> i <br /> ,: (For County Recorder Use) <br /> After recording return to: <br /> • <br /> Send all future tax bills to: <br /> • <br /> --APPLICATION TO REMOVE <br /> MANUFACTURED HOME FROM - <br /> COUNTY DEED RECORDS <br /> • YEAR MAKE HUD NUMBER VIN/SERIAL NUMBER WIDTH LENGTH <br /> - fq >35--- fieri wed e,OA 7 F1(031c111 <br /> HOME ID N�U� ER RECORDERS DOCUMENT NUMBER MAP&TAX LOT NUMBER <br /> t%/ A ct] x337. pie, (4( <br /> LEGAL DESCRFF[PPPTTTION: <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 /> • f <br /> I • <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 NA.MMIE OF 0044811(6)S J <br /> S[GNA FOh4tlGb'A"• <br /> SITUS ADDRESS <br /> - i i�77‘-°-' - 7 9g-t Liji .5+ Ll -I-37rig.r i 0R X73' <br /> SIGNATURE.' •' e.CA t,162_6j__Ap aja... MAILING ADDRESS <br /> (c-1-)0, rrctfoocf.r.._ a-cls (IA9'5x42 <br /> SECURED PARTY INFORMATI <br /> ^ <br /> NAME OF SECURED PARTY / <br /> ADDRESS OF SEC() PARTY <br /> / / <br /> 71J(tE/APPRO VAL,OF SECURED PARTY. <br /> *Omer and Secured party signatures must be notarized.Attach additional sheets if necessary. <br /> NOTARY: <br /> e_on County of <br /> The foregoing instrument was. .wledged before me this day of <br /> ,2O by <br /> Signature of Notary Public <br /> My commission expires: <br /> , <br /> rDEPARTMENT OF This certification is being submitted for recording to the county clerk for the county in which the real property is-located.N ' <br /> CC1N$UMEFS <br /> lSERVICS A copy of said recorded document is being provided to the State of Oregon Building Codes Division or one of its county <br /> ��BBU$INE$$ agents,along with the County Manufactured Home Notification and Tax Certification Form for Used Homes and a <br /> 440-5175(1/17/COM) Manufactured Home Bill of Sale/Change Application. <br /> 1 <br />