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.1 05 S I Sarcc4 O €rc <br /> SECTION 1 • NATURE OF FILING.(check all that apply):. .: - <br /> A4tr i e-t'oDS c er [ HCrxeliti n�a( teams ) <br /> [ dale eco as n o e <br /> ii 'ec • e ange erty status Nix Trip Permit <br /> y' ce a note): ' <br /> :',SECTION 2: • APPLICANT INFORMATION (please,print) ' a <br /> ❑■ Dealer/Seller ❑Lender CI Escrow/Title Agent ❑Owner/Buyer ❑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 ZIP:97322 <br /> Email:Isimon@jandmhomes.com <br /> $ECTION,3 HOME.INFORMATION.(iriformation in boldis required); : ,;,,= <br /> Home ID#: (V L Vv OR No Home ID: ■❑New Home ❑Out of state home ❑Leaving County Deed Records <br /> Manufacturer:CMH (, O 94 a l <br /> Model:72DRM28563CH24 Year:2024 <br /> Serial Number(s) HUD Label Number(s)*Required if new home <br /> ALB0432930RA <br /> AL8043293ORB <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: ❑Yes ❑■ No <br /> alapplicable) <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 underst nd it can be used as evidence in court and is subject to a penalty of perjury. <br /> Signature: gt.L. x ;dry 4fi') Date: T1a3A'7/ <br /> `:SECTION.5. ..` HOIVIE'LOCATION <br /> Current Address:2445 Pacific Blvd SW <br /> City:Albany County:Linn State:OR Zip:97321 <br /> Park Name:(if applicable) • ❑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:(f 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 />