OR Application to Remove Manufactured Structure from Exempt Status 1

APPLICATION TO REMOVE MANUFACTURED STRUCTURE FROM EXEMPT STATUS

Owner's Certificate of Legal Interest

EXEMPT FILE # __________________ X PLATE # ________________

INSTRUCTIONS: The following must be submitted to DMV:

1)This form, completed and signed by all parties with an interest in the manufactured structure. Each section of this form must be completed.

2)An application for Title and Registration For Manufactured Structures, Travel Trailers, or Special Use Trailers, Form 222, completed to show how the new title should be issued. Include fee payable to DMV Services.

3)A Title Report or Lot Book Report. (The title report or lot book report cannot be over 7 days old when submitted to DMV.)

4)Proof that all property taxes and special assessments for the current tax year have been paid. Proof may be a Certificate of Taxes Paid, Department of Revenue Form 113, issued by the county where the manufactured structure was located.

5)Check with the county where the manufactured structure is located for any notary requirements.

PART I LAND

Legal description and location of real property which is: (description as recorded by county recorder or a certified copy of your deed may be substituted).

__________________________________________________________________

__________________________________________________________________

__________________________________________________________________

If there is a mortgage, deed of trust or lien on this land, list all mortgagors, beneficiaries of deeds of trust below. Space is provided for two names and addresses and approval signatures If there are none, write "none."

Name and AddressApproval Signature

___________________________________________ ___________________

Name and AddressApproval Signature

___________________________________________ ____________________

Tax Lot Number (from assessor)Map NumberAccount Number

__________________________ ____________ _____________________

PART II MANUFACTURED STRUCTURE

Legal description of manufactured structure which is located on the real property described above:

Year Make Width Length Vehicle Identification Number(VIN)

____ ____ _____ _____ _____________________________

If there is a secured interest in the manufactured structure, list all security interest holders, mortgagees, beneficiaries of deeds of trust, and lien holders whose interest is secured by the manufactured structure below. Space is provided for two names, addresses, and approvals. If there are none, write "none."

Name and AddressSignature of Second Party*

________________________________________ x ________________________

Name and AddressSignature of Second Party

________________________________________ x ________________________

*Approval signatures DO NOT necessarily guarantee that lien holders will be shown on the title. A separate application (DMV Form 222) must be submitted specifically showing lien holders. If a lien has been satisfied, a statement of lien satisfaction MUST be attached.

Tax Lot Number (from assessor): ____________________________________________

___ I/We certify that the statements made above are accurate to the best of my knowledge. All liens, deeds of trust, mortgages and security interests have been listed. If there are none I have certified this by writing "none" in the space provided.

Printed Name of Owners(s)Telephone #

________________________________________________ ( ___ ) ______________

Printed Name of Owners(s)Telephone #

________________________________________________ ( ___ ) ______________

Signature of OwnerODL/ID/Customer #Situs Address

x _____________________ ________________ ________________________

Signature of OwnerODL/ID/Customer #Mailing Address

x _____________________ ________________ ________________________

Office use only PART III Office use only

Application for title for a manufactured structure previously exempt pursuant to ORS 820.510 is hereby approved. ____

Signature DateSignature of DMV Officer

_____________________ _______________________________________________

This Application is VOID if not recorded with the county by this date:

Expiration Date: ______________________

PART IV

Official Recording by County Clerk

_____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________