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tt & Ctr- Qd j½ mv t. ie, CAL- q S <br /> 'SECTION 1 ` NATURE OF FILING (check all that apply) : ;,. <br /> ❑ New home to MHODS ❑ A• dding or removing a co-owner 0 Demolition(Date: ) <br /> D Used home sale ❑ R• ecording as real property ❑ Converted to storage <br /> ❑ Security interest change ❑ Removing from real property status .0 Trip Permit <br /> ❑ Transfer by inheritance ❑ O• ther(please note): <br /> SECTION 2 APPLICANT INFORMATION (please pant) <br /> Ei Dealer/Seller ❑Lender ❑Escrow/Title Agent ❑OwnerBuyer ❑Legal Representative ,. <br /> Name:J&M Homes LLC Phone:541-928.-1471. <br /> (first,middle,last) <br /> Address:33213 Hwy 34 SE <br /> City:Albany State:OR LIP:97322 <br /> Email:Isimon@jandmhomes.com <br /> SECTION 3 . _ HOME INFORMATION(information m bold.,is required) <br /> -Home ID#: OR No Home ID: Q New Home ❑Out of state home ❑Leaving County Deed Records <br /> Manufacturer:C M H (DOB '1'1 ! <br /> Model:72PAR28563GH24 Year:2024 <br /> Serial Number(s) HUD Label Number(s) *Required if new home: <br /> ALB043108ORA <br /> ALB043108ORB <br /> #of Sections: 2 Sq.footage: 1521 Bedrooms: 3 Bathrooms: 2- <br /> Roofing type: Architectural Siding type: Vertical Wood Heating type: Electric Cooling type: None - <br /> - Date of sale: <br /> gapplicable) <br /> 3/28/23 Sale price: 157675 Includes land: ❑Yes 0 No <br /> ;SECTION 4 .DEALER�INFORMATION (leaveblank if no dealer) <br /> Name:J&M Homes LLC • , License#:MSD155 <br /> airst,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 /> 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 under91flA. <br /> nd it can be used as evidence in court and is subject to a penalty of perjury. <br /> Signature: Mit, 220112,94-- Date: � /5IcS <br /> 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 /> N This home is being moved to a new location Complete the section below <br /> New Address:11577 McClellan Rd <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 />