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3\ c 1 e,6 •"\- ;{ <br /> SECTION 1 NATURE-,� OF FILING (check all that apply) <br /> �ayra'h o-P�ITdfd1 ICY .thagiaftkrki iz,ing o5vrier ncI1it tVE)l e: <br /> s 1 ttszte.sale r ) Alp/duct t ora e <br /> t ' e ) fi r p PRtus 0 Trip Permit <br /> s ei 'tii tatfce\ reNzote): <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:541-928-1471. <br /> (first,middle,last) <br /> Addiess: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#: OR No Home ID: Q New Home ❑Out of state home ❑Leaving County Deed Records <br /> Manufacturer:CM H <br /> Model:72DRM28443AH23 Year:2023 <br /> Serial Number(s) HUD Label Number(s)*Required if new home <br /> ALB0424380RA <br /> ALB0424380RB <br /> #of Sections: 2 Sq.footage: 1188 Bedrooms: 2 Bathrooms: 2 - <br /> Roofing type: Architectural Siding type: Vertical Wood Heating type: Electric Cooling type: None <br /> Date of sale: 11/3/22 Sale price: <br /> r <br /> afapplicableJ p 147622 Includes land: El Yes No <br /> SECTION 4 DEALER INFORMATION (leave blank if no dealer) <br /> Name`J&M Homes LLC <br /> (fast,middle,lash License#:MS D 155. <br /> Address:15850 S Pope Ln <br /> City:Oregon City State:OR ZIP:97045 <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. <br /> Signature:(*AA__ 4/M4Yr) Date: ..?/j// 3 <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 /> ■❑This home is being moved to a new location Complete the section below <br /> New Address:315 Clester Rd <br /> City:Detroit County:Marion State:OR Zip:97342 <br /> Park Name: (if 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:lsimon@jandmhomes.com <br /> Page 2 <br />