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--I -79N HE SOL24k OLYY-) V 1/1 CI' <br /> • NATURE OF FILING (check all that applies) <br /> &y, . se, i t: rst iN! 6ra !, Ok ,C1‘ I- Pol-.2n 6.1 - • lei. • itVIVVV\VI"' <br /> Elycjrc. g e. psiatAFacatiavia‘frOVAL tAa req/UtusElilrippermit . . o -rt:d,o sr,Is <br /> VAL: <br /> • <br /> ••• APPLICANT INFORMATION <br /> El Dealer/seller 1E Lender E Escrow/title agent Owner/buyer El 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 /> • <br /> MATION <br /> Home ID number(if known): <br /> DMV X-plate number(if known): <br /> (. .o3cad4 <br /> E 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: E Yes No <br /> •••'•:• , ••• - • DEALER-INFORMATIOR:(lUnii dealer, 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 /> ['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 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 /> ••' <br /> TRANSPORTER INFORMATION moving, leave blank) • <br /> TION Of- : .•••• • <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(7/17/COM) Page 2 <br />