Laserfiche WebLink
(0 0 `3 ;, -1- }korn SE <br /> YDn5 <br /> NATURE OF FILING (check all that applies) <br /> ❑kcil nge rty to• st ES)31age ersh' eT i 1' to Ira 7. 8 de -: rtio . <br /> e or 'n as al rop m.vi•: fro. r:.1 : •: . 4 tus El Trip permit , v d o' o e <br /> her: <br /> APPLICANT INFORMATION <br /> $Dealer/seller ❑Lender ❑ Escrow/title agent ❑ Owner/buyer ❑ Legal representative <br /> Name:J&M Homes <br /> Address(including city,state,and ZIP):12901 SE 97th Ave.#100 Clackamas, OR 97015 <br /> Phone:503-908-1866 <br /> Email:tmelchior@jandmhomes.com <br /> HOME INFORMATION (*required) <br /> Home ID number(if known): DMV X-plate number(if known): ,1 <br /> pO3(p,2-1 <br /> ❑Moving in from another state <br /> Has no home ID or X-plate because: ❑Coming out of county deed records <br /> Q Other:Brand new home <br /> Manufacturer:CMH Model:55CBC28483AH22 Year:2022 <br /> Manufacturer serial number HUD number <br /> HER0332450RA <br /> HER033245ORB <br /> *Number of sections:2 *Square footage:1280 *Number of bedrooms:2 *Number of bathrooms:2 <br /> *Type of roofing:Architectural *Type of siding:Vertical wood *Heating:Electric *Cooling:None <br /> *Date of sale:6/24/21 *Sales price:139426 *Includes land: ❑Yes 0 No <br /> no dealer, leave blank) <br /> INFORMATION (if <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 /> 503-908-8166 <br /> Q 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 /> TRANSPORTER INFORMATION (if not moving, 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(7/19/COM) Page 2 <br />