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...SECTION NATURE OF FILING(check all that apply) ._. ._ <br /> /2\A����o A ' a r �� <br /> ,A ). . <br /> �¢ "Vyw 'Sale' a d' a ed to storage :• :`: ' <br /> SC(Weekolf6Rde e g pe status 0 Trip Permit <br /> __ r is Miliitance er note <br /> .SECTION 2 APPLICANT INFORMATION (please print) - <br /> ❑Dealer/Seller ❑Lender ❑Escrow/Title Agent ❑Owner/Buyer ❑Legal Representative <br /> Name:J&M• Homes LLC .Phone:541--928=1471. <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#: OR No Home ID: 0 New Home ❑Out of state home 0 Leaving County Deed Records._-_ <br /> Manufacturer:CMH - (o -0 a-33 .1.... _ :.._-. <br /> Model:72DRM28563BH22 • Year:2022 - - <br /> Serial Number(s) HUD Label Number(s)*Required if new home "' - ' <br /> . .. , ALB0419200RA • NTA2120899 <br /> ALB041920ORB NTA2120900 <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..1 <br /> Date of.sale: .7/10/23 Sale price: 135655 Includes land: ❑Yes ❑■ No • .. <br /> _ . ...afapplicable) <br /> SECTION 4 - DEALER INFORMATION(leave blank if no dealer) -_ <br /> Name'J&M Homes LLC License#:MSD155 .. ... <br /> (first,middle,last) <br /> ' Address:15850 S Pope Lane . . . - <br /> City:Oregon City State:OR ZIP:97045 <br /> Email:dasla@jandmhomes.com Phone:503-908-8166 <br /> Ihereby declare this manufactured structure is free and clear of all mortgages,deeds of trust,security interests,and liens.Ihave 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 underst d it can be used as evidence in court and is subject to a penalty of perjury. <br /> Signature: Date: ? ,2? 2 <br /> SECTION 5 HOME LOCATION <br /> Current Address:33213 Hwy 34 SE <br /> City:Albany County:Linn State:OR Zip:97322 <br /> Park Name: (ef applicable) ❑■ This is a dealer lot or storage facility <br /> 0 This home is being moved to a new location Complete the section below <br /> New Address:5486 Anderson Rd SE <br /> City:Aumsville County:Marion State:OR Zip:97325 <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:Isimon@jandmhomes.com <br /> • Page 2 <br />