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per Aci) NE. 51. P, • <br /> SECTION i NATURE OF FILING(check all that apply) • <br /> 60 1D4 Ali iNatiSov ier atice <br /> ckAtaaiAlkrafale t2114.4dittglelVerLoatferty 261w&14 c d e1 ge <br /> • ® ri r(k e •r a s Q Trip Permit <br /> grVaigfeWilikbptIStAr UAVAl ula sr + :— • <br /> SECTION 2 APPLICANT INFORMATION (please print) <br /> ®❑Dealer/Seller ❑Lender ❑Escrow/Title Agent ❑Owner/Buyer ❑Legal Representative <br /> Name` <br /> Urst,middle,last)J&M Homes LLC Phone:503-908-8.166 <br /> Address:15850 S. Pope Lane <br /> City:Oregon City State:OR ZIP:97045 <br /> Email:aspencer@jandmhomes.com <br /> SECTION 3 HOME INFORMATION (information in bold is required) <br /> Home ID#: OR No Home ID: 0 New I lone 0 Out of state home ❑Leaving County Deed Records <br /> Manufacturer:CMH MFG, West Albany t✓p d q 1 9 -] <br /> Model:DRM562F Year•:2024 <br /> Serial Number(s) HUD Label Number(s) *Required if new home <br /> • ALB0430950RA NTA2239855 <br /> • ALB043095ORB NTA2239856 • <br /> #of Sections: 2 Sq..footage: 1,512 Bedrooms: 3 Bathrooms: 2 • • <br /> Rootingtype:_ Architectural Siding type: Vertical Wood Heating type: Electric Cooling type: None • <br /> Date of sale: 1/3/2024 Sale price: $158,255.00 Includes land: ❑Yes ®❑No <br /> (If applicable) <br /> 'SECTION 4...(. DEALER INFORMATION(leave blank if no dealer) • <br /> Name:J&M Homes LLC License#:MSD-155 <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 /> 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 understand it can be used as evidence in court and is subject to a penalty of perjury. <br /> . <br /> • 11/ <br /> Signature: n 5Sem � /� Date: /00)-- <br /> "SECTION 5• F 7 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 /> N This home is being moved to a new location Complete the section below <br /> New Address:22312 River Rd. NE <br /> City:St. Paul County:Marion . State:Or Zip:97137 <br /> Park Name: (if applicable) 0 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 />