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
_____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________
No guidelines are available for this form at this time.