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i 4-h • <br /> Niro <br /> NATURE OF FILING (check all that applies) <br /> Vkiiitic19,9014,144erest ■❑ Change ownership of 'oi a f i ' . <br /> e • in a rty no 'i fr n r r pty p tit torage <br /> •5-ether: <br /> APPLICANT INFORMATION - • <br /> 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:503-908-8166 <br /> Email:aspencer@jandmhomes.com . <br /> HOME INFORMATION (*required) <br /> Home ID number(if known): . DMV X-plate number(if known): Goo q4 <br /> IQ& W C59 <br /> n Moving in from another state <br /> • <br /> Has no home ID or X-plate because: ❑ Coming out of county deed records <br /> Q Other:New Home <br /> Manufacturer:CMH MFG,West Albany Model:Dream 481 M • Year:2022 <br /> Manufacturer serial number HUD number <br /> ALB0414640RA NTA2141662 <br /> *Number of sections:1 *Square footage:648 *Number of bedrooms:2 *Number of bathrooms:1 <br /> *Type of roofing:Architectural *Type of siding:Vertical Wood *Heating:Electric *Cooling:None <br /> *Date of sale:2/8/2022 *Sales price:$75,255.00 *Includes land: ❑ Yes •No <br /> DEALER INFORMATION (if no dealer, leave blank) <br /> Dealer name: Dealer license number: Dealer address and phone: <br /> J &M Homes, LLC MSD-155 12901 SE 97th Ave. #100 <br /> Clackamas, OR 97015 <br /> 503-908-8166 <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 /> • <br /> J &M Homes, LLCrt1/17111SPe,146-9- j^ <br /> TRANSPORTER INFORMATION (if not moving, leave blank) <br /> Transporter name: Transporter address and phone: <br /> • <br /> 440-2952(7/19/COM) Page 2 • <br />