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35 "ruL_ITh--)b le_ DR q -734 <br /> SECTION 1 NATURE OF FILING(check all that apply) <br /> UAIIIAleme-t,elskr0196 Y e r e i <br /> e tijQn.re•eate m p <br /> ic.1",tr,ityibtopesullange ea a rs II Trip Permit <br /> r kih-Nitaase EUDethapielke,fitteA <br /> SECTION 2 APPLICANT INFORMATION (please print) <br /> El Dealer/Seller ❑Lender ❑Escrow/Title Agent ❑Owner/Buyer ❑Legal Representative <br /> Name:J&M Homes LLC Phone:541-928-1.471 <br /> Urst,middle,last) <br /> Address:33213 Hwy 34 SE <br /> City:Albany State:OR ZIP:97322 <br /> Email:Isimon@jandmhomes.com <br /> SECTION 3 HOME INFORMATION (information in bold is required) <br /> Home ID#: j V� OR No Home ID: Q New Home ❑Out of state home ❑Leaving County Deed Records <br /> Manufacturer:CMH (PO(oio 9 <br /> Model:72PAR28563BH23 Year:2023 <br /> Serial Number(s) HUD Label Number(s)*Required if new home <br /> ALB042504ORA - <br /> ALB042504ORB <br /> #of Sections: 2 Sq.footage: 1512. Bedrooms: 3 Bathrooms: 2 <br /> ",Roofing type: Architectural Siding type: Vertical Wood Heating type: Electric . Cooling type: None --- <br /> Date of sale: 1/30/23 Sale price: 166896 Includes land: ❑Yes ❑� No <br /> (Ifapplicable) <br /> SECTION 4 DEALER INFORMATION (leave blank if no dealer) <br /> Name <br /> airs!,middle,last.)J&M Homes LLC License#:MSD155 <br /> Address:12901 SW 97th Ave, Suite 100 <br /> City:Clackamas State:OR ZIP:97015 <br /> Email:dasla@jandmhomes.com Phone:503-908-8166 <br /> I.hereby declare 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 or my interest in it. The information listed is true to the best of my knowledge and <br /> belief,and I understand it can be used as evidence in court and is subject to a penalty of perjury. 3 <br /> Signature: �/'( A 401,(9� Date: 579/2 <br /> SECTION 5 ��"// HOME LOCATION <br /> Current Address:2445 Pacific Blvd SW <br /> City:Albany County:Linn State:OR Zip:97321 <br /> Park Name: (if applicable) ❑This is a dealer lot or storage facility <br /> ❑Q This home is being moved to a new location Complete the section below <br /> New Address:135 Tumble Dr <br /> City:Detroit County:Marion State:OR Zip:97342 <br /> Park Name: (f applicable) ❑This is a dealer lot or storage facility <br /> Transporter Name:J&M Homes LLC Phone: 541-928-1471 <br /> Address:33213 Hwy 34 SE City: Albany State: OR <br /> Email:Isimon@jandmhomes.com <br /> Page 2 <br />