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01\2- T3P-S- <br /> eA, �INGYTV5Vi <br /> SECTION 1 NATURE^:OF FILING(check all that'apply) _ ' <br /> El New home to MHODS El Adding or removing a co-owner ❑ Demolition(Date: ) <br /> El Used home sale ❑ Recording as real property ❑ Converted to storage <br /> El Security interest change El Removing from real property status Trip Permit <br /> El Transfer by inheritance El Other(please note): <br /> SECTION 2 APPLICANT,INFORMATION (please Print) <br /> Dealer/Seller ❑Lender ❑Escrow/Title Agent 0 Owner/Buyer El 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 LU:97322 <br /> Email:Isirnon@jandmhomes.com <br /> SECTION 3 HOME INFORMATION(information in bold.is required) <br /> Home ID#: N G W OR No Home ID: ❑■ New Home ❑Out of state home ❑Leaving County Deed Records <br /> Manufacturer:C M H (`j( r2 -71- q <br /> Model:72PAR28563GH24 Year:2024 <br /> Serial Number(s) HUD Label Number(s) *Required if new home <br /> ALB0431080RA <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: 3/28/23 Sale price: 157675 Includes land: ❑Yes ❑1■ No <br /> gapplicable) <br /> SECTION 4 ;, DEALER INFORMATION (leave blank if no dealer) <br /> Name' <br /> first,middle,last)J&M Homes LLC License#:MSD155 <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 unders nd it can be used as evidence in court and is subject to a penalty of perjury. <br /> Signature: 4/tiuJ60 I" Date: aht../.7i/ <br /> SECTION 5 = <br /> ...:. � ::: ,HOME LOCATION. <br /> Current Address:2445 Pacific Blvd SW <br /> City:Albany County:Linn State:OR Zip:97321 <br /> Park Name: (f applicable) El This is a dealer lot or storage facility <br /> Ci 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 />