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1 05 1 30._pcc4oj ck DR . E S <br /> SECTION 7 NATURE OF FILING(check all that apply) <br /> Wii.eallaie-CMHZ$DS r c er EPHetmsl''' ntt j9at® - ) <br /> [ d'liatne-sale eco as n o s e <br /> ec ec st'cfiange erty status Trip Permit <br /> y' ce a note): <br /> SECTION 2. '.:. : `.;',:;; ` : • APPLICANT INFORMATION (please print) <br /> ❑- Dealer/Seller ❑Lender D Escrow/Title Agent ❑Owner/Buyer ❑Legal Representative <br /> Dame:J&M Homes LLC Phone:541-928-1471 <br /> Psi,middle,last) <br /> Address:33213 Hwy 34 SE <br /> City:Albany State:OR ZIP:97322 <br /> Email:Isimon@jandmhomes.com <br /> SECTION 3 HOME INFORMATION (information m bold is required) r <br /> Home ID#: VV OR No Home ID: Q New Home ❑Out of state home ❑Leaving County Deed Records <br /> Manufacturer:CMH 60 O 94 q <br /> Model:72DRM28563CH24 Year:2024 <br /> Serial Number(s) HUD Label Number(s)*Required if new home <br /> ALB0432930RA <br /> ALB043293ORB <br /> #of Sections: 2 Sq.footage: 1512 Bedrooms: 3 Bathrooms: 2 <br /> Roofing type: Architectural Siding type: Cement Lap Heating type: Electric Cooling type: None <br /> Date of sale: 2/7/24, Sale price: 136015 Includes land: 0 Yes 0 No <br /> (If applicable) <br /> ;SECTION 4 ' '. DEALER;INFORMATION(leave'blank if no dealer):` <br /> Name'J&M Homes LLC License#:MSD155 <br /> first,middle,last) <br /> Address:15850 S Pope Lane <br /> City:Oregon City State:OR LIP: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 Iiens.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 underst nd it can be used as evidence in court and is subject to a penalty of perjury. <br /> Signature: - x ' vmg Date: 11a3 2 y <br /> SECTIO - <br /> • .. .. :., ..NS�''. .,.;;.''�:.:.�::.::�:�' � .'. � '. , : HOME LOCATION ..,. :, .. . <br /> Current Address:2445 Pacific Blvd SW <br /> City:Albany County:Linn State:OR Zip;97321 <br /> Park Name:(if applicable) • 0 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:10581 Saratoga Dr NE <br /> City:Salem County:Marion State:OR Zip:97305 <br /> Park Name:(if applicable) 0 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 />