Returned at Counter

2026-002004

Klamath County, Oregon
After recording return to;
00353641202600020040010018
Send all future tax bills to: 2 2AV1 D l ( ?QLEMAIL 03/06/2026 12:17:03 PM
A7 Fee: .
P o 507( Q ee: $87.00
Keno or Q76 27
APPLICATION FOR RECORDING MANUFACTURED HOME AS REAL PROPERTY
Check appropriate box: o _New home ®& Existing home - X Platc Number (if applicable)
LEGAL DESCRIPTION OF MANUFACTURED STRUCTURE
YEAR MAKE grgé)g.%fgg]{ Vg?]g,“LZECIgIZEN?FICATION NUMBER (VIN) | WIDTH LENGTH
- 7R lO '
2010 [fuavh | opcsiaios H 312 0927 BI(O 30 ft |L6ft8in
HOME ID COUNTY ID NUMBER | SITUS ADDRESS
352-1(5 596876 18108 Ponderosn LN KuamatnFass OR q 7601
Legal description per ORS 93.600 or reference number of previously recorded decd. (Attach additional sheets, if needed.)
Map and tax lot number:
3467- 02DO- 4100 (Dm:\ No. 2D)2- 002675)
PRINTED NAME OF OWNER(S) Rk Dawvd L _Colomen, Trasfe
Self - Declaration oFTFosf‘or Dowid L. Golerman Aqrezmedd Doked 11 cLrm:Y 12003
PRINTED NAME OF OWNER(S) (For additional owners, attach a second sheet) Barbows &. Colemicar, Trustec
Self -declarahin oF Tast of Barbare. G.Chemon Ayament Doled 10 fbivary 2003
MAILING ADDRESS (If different than situs address)
P.O B Gl Keno OR 27¢27-0411
SEC}URITY INTEREST HOLDER NAME AND ADDRESS (If no sccurity interest holder, writc “nonc.” Attach additional sheet if needed.)
, Nore /a
0/ 0 \ k }\},\ /U ACKNOWLEDGEMENT 3 /
" g U _ / S12082.(
C(;?nty asSesSor/tax collector or escrow officer Date
CERTIFICATION
1 certify that, according to ORS 446.626:
¢ The same person owns the manufactured structure and the real property as described above on which the manufactured structure
is or will be situated OR
+ The owner of the manufactured structure holds a recorded leasehold estate of 20 or more years of the land;
o The manufactured structure is or will be affixed to the real property and subject to taxation by the county in which it is located as
an improvement to the real property;
¢ Each person with a sccurity intcrest in the manufactured structure and cach person with a sccurity interest in the rcal property
approves the exemption from ownership document; and
¢ This certification is being submitted for recording to the county clerk for the county in which the real property is located. A copy
of said recorded document is being provided to the county assessor in addition to the State of Oregon Building Codes Division,
or onc of its county agents algag with the County Manufactured Home Notification and Tax Certification Form for Used Homes
and a Manufactured llome B alg/C e Application.
X SIGNATURE OF OWNER -
X SIGNATURE OF OWNER Y
State of Oregon, County of _Klamat
The foregoing instrument was acknowledged before me this
S%  dayof _ NA ,20
~3e Bech e OFFICIAL STAMP
by D 2 < 2 JONESSA HOOD
Signature of notary public: NOTARY PUBLIC - OREGON
M fegi ires: S .2 5 1040835
y commission cxpires ot 4, 2027 W m 24, 2027
BCD &

Department of Consumer
and Business Services

440-5176 (12/24/COM) Page | 1