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Cs° <br /> Trnr PS (E 117 ScJer- ) <br /> SECTION1;�:.' .>� - : ..... .. NATURE OF>FILING.(checkall that apply) = , `' : s ; ::�: . ::;;;'�.:.:.. ::':•`: <br /> W{'V }t NpNLIODS a.Adaliwrefriehmovigner i e• ) <br /> cfSk a nfe sake r ing-as-talzapecty a..Cerverretl-te-gterage <br /> e ge m erty status Na Trip Permit <br /> e r <br /> SECTION 2. z: APPLICANT:INFORMATION:(please print). >. <br /> N Dealer/Seller ❑Lender ❑Escrow/Title Agent ❑Owner/Buyer ❑Legal Representative <br /> Name. <br /> J&M Homes LLC Phone:541-928-1471 <br /> (first,middle,last) <br /> Address:33213 Hwy 34 SE <br /> City:Albany State:OR LIP:97322 <br /> Email:Isimon@jandmhomes.com <br /> SECTION 3., „ ;. „, , HOME.INFORMATION.(information in bold is required) <br /> Home ID#: OR No Home ID: ❑■ New Home ❑Out of state home ❑Leaving County Deed Records <br /> Manufacturer:C M H CD O q fC'1,.0 <br /> Model:72DRM28443AH24 Year:2024 <br /> Serial Number(s) HUD Label Number(s)*Required if new home <br /> ALB0432800RA NTA2239899 <br /> AL60432800RB NTA2239900 <br /> • <br /> #of Sections: 2 Sq.footage: 1350 Bedrooms: 2 Bathrooms: 2 - <br /> Roofing type: Architectural Siding type: Vertical Wood Heating type: Electric Cooling type: H eat Pump <br /> Date of sale: 4/15/24 Sale price: 194536.69 Includes land: El Yes No <br /> afapplicable) <br /> SECTION 4 DEALER;INFORMATIONr(leave blank;If no.dealer) <br /> Name:J&M Homes LLC(first,middle,last) License#:M S D 155 <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 usgd as evidence in court and is subject to a penalty of perjury. <br /> b Signature: 24Jyyz'17 Date: V 23`2 <br /> SECTIONS: ';:;' : ' HOME LOCATION <br /> Current Address:2445 Pacific Blvd SW <br /> City:Albany County:Linn State:OR Zip:97321 <br /> Park Name:of 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: (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 />