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: , cyc T-059 P0002/0005 F-265
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<br /> IN Dealer/seller ❑Lender 0 Escrow/title agent ❑ Owner/buyer 0 Legal representative
<br /> Name:J&M Homes, LLC
<br /> Address(including city,state,and ZIP):12901 SE 97th Ave #100, Clackamas,OR 97015
<br /> Phone:503-722-4500
<br /> Email:salesserviceoc@jandmhomes.com
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<br /> Home ID number(if known): DMV X-plate number(if known):
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<br /> 'fib. ❑Moving in from another state
<br /> Has no home ID or X-plate because: ❑Coming out of county deed records
<br /> Fr Other:
<br /> Manufacturer:CMH Manufacturing-West Model:DFiM 483r Year:2021
<br /> Manufacturer serial number HUD number
<br /> ALB0404140RA
<br /> ALB040414ORB
<br /> *Number of sections:2 *Square footage: 1296 *Number of bedrooms:3 *Number of bathrooms:2
<br /> *Type of roofing:Comp *Type of siding:Comp [ i-ieating:Electric 1 *Cooling:None
<br /> *Date of sale:1/10/21 *Sales price:97,057.00 *Includes land: ❑Yes Q No
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<br /> Dealer name: Dealer license number: Dealer address and phone:
<br /> J&M Homes, ILC MSD155 12901 SE 97th Ave #100
<br /> Clackamas,OR 97015
<br /> 503-908-8166
<br /> 0 This manufactured structure is free and clear of all mortgages,deeds of trust,security interests,and liens,I have the
<br /> legal right to sell this manufactured structure.
<br /> I hereby declare that the above statement is true to the best of my knowledge and belief,and that['understand it is
<br /> made for use as evidence in court and is subject to penalty for perjury.
<br /> Dealer name(print): ler(signature:) Date:
<br /> J&M Homes, LIC • 6V - t 4A\/t- 3/11/21
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<br /> Transporter name: Transporter address and phone:
<br /> 440-2952(7/r7/con) Page 2
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