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, i -: CD nr le -,eAe/ SA- . g , 0 E_A-N r O j— <br /> ,SECTION..? ,. NATURE;OF FILING(check all.that apply)' .: -- - <br /> isLANattnizAnters;ase o ' -o er [ 1 entklig e: ) <br /> W3ke,d'hqata�aleP Perty rt<el tns-sforage <br /> g age e tatus 0 Trip Permit <br /> y c e• n e : <br /> .SECTION 2. ?- :.APPLICANT,INFORMATION.,(please,pnnt) -, ; _ <br /> ❑U Dealer/Seller ❑Lender El Escrow/Title Agent 0 Owner/Buyer 0 Legal Representative <br /> N,ae:J&M Homes LLC Phone:541-928-1471 <br /> (first,middlelmast) <br /> Address:33213 Hwy 34 SE <br /> City:Albany State:OR ZIP:97322 <br /> Email Isimon@jandmhomes.com (pOT:771-1 1 <br /> SECTION_3� , _HOME INFORMATION (mformatton m bold is required)Y „, <br /> Home ID#: NI'IA) OR No Home ID: 0 New Home ❑Out of state home ❑Leaving County Deed Records <br /> Manufacturer:CMH <br /> Model:72DRM28443AH23 Year:2023 <br /> Serial Number(s) HUD Label Number(s)*Required if new home <br /> ALB0428920RA <br /> ALB042892ORB <br /> #of Sections: 2 Sq.footage: 1620 Bedrooms: 3 Bathrooms: 2 <br /> Roofing type: Architectural Siding type: Stained Lap Heating type: Electric Cooling type: Heat Pump <br /> Date of sale: 8/13/23 Sale price: 206115 Includes land: ❑Yes E1 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 Lit':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 understa d it can be used as evidence in court and is subject to a penalty of perjury. <br /> Signature: ' Ott_ /6,0 ') Date: Iiii/.2 3 <br /> SECTIONS :.::::;..:3 HOME LOCATION <br /> Current Address:2445 Pacific Blvd SW <br /> City:Albany County:Linn State:OR Zip:97321 <br /> Park Name: (if applicable) 0 This is a dealer lot or storage facility <br /> l This home is being moved to a new location Complete the section below <br /> New Address:230 Meyer St S <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 />