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River Rd /UE 84 p <br /> L a Lt <br /> " SECTION 1 NATURE OF FILING(check all that apPly) <br /> IEJUIVNeawatErronteos 4211.Aituompeultkittygrtraroklher ElnieklAiPeUitaq ) <br /> ; e 10/IteCirraitaaslet&pwritrty r_S-"FtaledkerAert%e <br /> g21/3getetylatettsko1Itrage • tus El Trip Permit <br /> ISINTaltastj:ebyiVViigra- clioat(placla1ark., <br /> SECTION APPLICANT INFORMATION (please print) <br /> 12]Dealer/Seller 0 Lender 0 Escrow/Title Agent El Owner/Buyer 0 Legal Representative <br /> Name'(first,middle,last)J&M Homes LLC Phone:503-908.-8166 <br /> Address:15850 S. Pope Lane <br /> City:Oregon City State:OR ZIP:97045 <br /> Email:aspencer@jandmhomes.com <br /> SECTION 3 1 HOME INFORMATION (information in bold is required) <br /> Home ID#: OR No Home ID: 0 New Home 0 Out of state home 0 Leaving County Deed Records <br /> Manufacturer:CMH MFG, West Albany q I <br /> Model:Tempo-Under Pressure Year:2024 <br /> Serial Number(s) HUD Label Number(s) *Required if new home <br /> ALB0430960RA NTA2239860 <br /> ALB043096ORB NTA2239861 <br /> #ofSections: 2 Sq.footage: 1,296 Bedrooms: 3 Bathrooms: 2 <br /> Roofing type: Architectural Siding type: Vertical Wood Heating type: Electric Cooling type: None <br /> Date of sale: 1/3/2024 Sale price: $131,402.00 Includes land: 0 Yes No <br /> afapplwable) <br /> SECTION 4 DEALER INFORMATION(leave blank if no dealer) <br /> License#:MSD-1 55 <br /> Name: IR Homes LLC <br /> (first,middle,las0"41AA" <br /> Address:15850 S Pope Lane <br /> city:Oregon City State:OR ZIP:97045 <br /> Email:dagla@jandmhomes.com Phone:503-908-8166 <br /> I hereby declare this manufactured structure is free and clearof 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:074(4 Spe/1) e/k--- Date: <br /> SECTION 5 HOME LOCATION <br /> Current Address:2445 SW Pacific Blvd. <br /> City:Albany County:Linn State:Or Zip:97321 <br /> Park Name: (if applicable) This is a dealer lot or storage facility <br /> 1=1 This home is being moved to a new location Complete the section below <br /> New Address:22314 River Rd. NE#4 <br /> City:St. Paul County:Marion State:Or Zip:97137 <br /> Park Name: a f applicable) El This is a dealer lot or storage facility <br /> Transporter Name:J&M Homes LLC Phone: 503-908-8166 <br /> Address: 15850 S Pope Lane City: Oregon City State: OR <br /> Email:aspencer@jandmhomes.com <br /> Page 2 <br />