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HE Se,_.,Th1--toax- v 1/1 CI' <br /> : ::;: NATURE OF:FIL.�ING ch'e:ck;all,that a Lies <br /> L\� ' . se, i- t: :st O. ►r -.,s •.n I- Autaii:VVA <br /> : <br /> RV • Dore. g e: p •.•e Ly ,uavtni fro e ro rt s us ■❑Trip permit o rt d o t r <br /> Kt\tller: <br /> • APP.LICAfNT.INFORMAT ON' <br /> El Dealer/seller ❑Lender ❑Escrow/title agent ❑ Owner/buyer ❑ 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 <br /> :HOME INFORMATION,(* ra0,ired)• <br /> Home ID number(if known): ^ DMV X-plate number(if known): <br /> M E ( O3(cia4 <br /> ['Moving in from another state <br /> Has no home ID or X-plate because: ❑Coming out of county deed records <br /> ❑Other: <br /> Manufacturer:CMH Marlette Hermiston Model:CMH Marlette CR 2023 Year:2021 <br /> Manufacturer serial number HUD number <br /> HER0328740RA <br /> HER032874ORB <br /> *Number of sections:2 *Square footage:1493 *Number of bedrooms:3 *Number of bathrooms:2 <br /> *Type of roofing:Comp *Type of siding:Vertical *Heating:Elect *Cooling:None <br /> *Date of sale:1/19/2021 *Sales price:118,787.00 *Includes land: ❑Yes 0 No <br /> :... .:.'. .. .' • . :.: .. ..............DE <br /> A E I <br /> L R NF <br /> .. ,IIIIAi'ION:: f:no <br /> .. .. . ..... .: . Q4�.... . .:- 1 leave blank. <br /> Dealer name: Dealer license number:' Dealer address and phone: <br /> J&M Homes, LLC MSD155 12901 SE 97th Ave.#100 ' <br /> Clackamas, OR 97015 <br /> • <br /> sThis 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 I understand it is <br /> made for use as evidence in court and is subject to penalty for perjury. <br /> Dealer name(print): Dealer signature: Date: <br /> J &M Homes, LLC <br /> TRANSPORTER INFORMATION'Of not moumg, Leave blank) ' . <br /> Transporter name: Transporter address and phone: <br /> J&M Homes, LLC 12901 SE 97th Ave, #100 <br /> Clackamas, OR 97015 <br /> 503-908-8166 <br /> 440-2952(7/I7/COM) Page 2 <br />