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Tr PC) SE SJ€ <br /> NATURE OF FILING(check all that apply)INVWX ..> . <br /> Slaty DS a D e• <br /> cE4-4,1selibrtINalee ajte6iiting.asit—gspropefty [L Cenvafett-tasterage <br /> El... -ehange m erty status Trip Permit <br /> itarIDe [ t� re ( ease gatel:� <br /> SECTION,2::e :;,::: :... . _ APPLICANT:INFORMATION lease rint :,:;:`'': . :,. f ..;,,`:'.. <br /> Dealer/Seller 0 Lender ❑Escrow/Title Agent ❑Owner/Buyer ❑Legal Representative <br /> Nam <br /> e,lase`J&M Homes LLC Phone:541-928-1471 <br /> first,middt)l <br /> Address:33213-Hwy 34 SE <br /> City:Albany State:OR ZIP:97322 <br /> Email:Isimon@jandmhomes.com <br /> 'SECTION 3 k HOME INFORMATION(information in bold is required) <br /> Home ID#: OR No Home ID: Q New Home ❑Out of state home ❑Leaving County Deed Records <br /> Manufacturer:CMH (oO 9 ictt) <br /> Model:72DRM28443AH24 Year:2024 <br /> Serial Number(s) HUD Label Number(s)*Required if new home <br /> ALB0432800RA NTA2239899 <br /> ALB0432800RB NTA2239900 <br /> II of Sections: 2 Sq.footage: 1350 Bedrooms: 2 Bathrooms: 2 <br /> Roofing type: Architectural Siding type: Vertical Wood Heating type: Electric Cooling type: Heat Pump <br /> Date of sale: 4/15/24 Sale price: 194536.69 Includes land: ❑Yes ■ No <br /> ('applicable) 4/15/24 <br /> SECTION 4 DEALER.INFORMATION(leave blank;if no dealer): <br /> Name:J&M Homes LLC(first,middle,last) 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 understand it can be used as evidence in court and is subject to a penalty of perjury. <br /> Signature: Nll�l• IIL/4,9Y) Date: 443`2� <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:(if applicable) Paradise Island Park ❑This is a dealer lot or storage facility <br /> ■❑This home is being moved to a new location Complete the section below <br /> New Address:3100 Turner Rd#117 <br /> City:Salem County:Marion State:OR Zip:97302 <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 />