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ci37 Ea RVnO Scq133--J, <br /> SECTION 1:; NATURE.OF FILING(check all,thata I ): :. <:.:>. , :;:;.,`.. ;::.:=`;::... <br /> q\bI wNonivoNly S t iky r er lit.BaiiitietrOszate <br /> g'W�o .gale cor ' lc ❑Ce nver d-to storage <br /> ty status 0 Trip Permit <br /> e O r ote): <br /> .:SECTION 2 •'. . APPLICANT:INFORMATION (pleasprint) .' <br /> 0 Dealer/Seller ❑Lender 0 Escrow/Title Agent ❑Owner/Buyer 0 Legal Representative <br /> Name: <br /> first,middle,last)J&M Homes LLC Phone:541-928-1471 <br /> Address:33213 Hwy 34 SE <br /> City:Albany State:OR ZIP:97322 <br /> Email:Isimon@jandmhomes.com <br /> .SECT :H On l0N 3 ,. ; ,. :- OME INFORMATI ...N(mformatonm bold is required)„ y,;_. 4 <br /> Home ID#: I J E V OR No Home ID: Q New Home 0 Out of state home ❑Leaving County Deed Records <br /> Manufacturer:CMH &O 7 I C () <br /> Model:72DRM28483CH24 Year:2024 <br /> Serial Number(s) HUD Label Number(s)*Required if new home <br /> ALB0431610RA NTA2233320 <br /> ALB043161 ORB MTA2233321 <br /> #of Sections: 2 Sq.footage: 1296 Bedrooms: 3 Bathrooms: 2 <br /> Roofing type: Architectural Siding type: Vertical Wood Heating type: Electric Cooling type: None <br /> Date of sale: 33/1 /24 Sale rice: <br /> afapplicable) P 141312.01 Includes land: ❑Yes ❑p No <br /> SECT_ION 4 f „ DEALER:INFORMATION,(leave:blank if no(1ealer),; . <br /> Name:J&M Homes LLC License#:MSD155 <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 understa d it can be used as evidence in court and is subject to a penalty of perjury. <br /> Signature: egtk, e&Alterr) Date: 211z511/z.L1 <br /> ::SECTIIONS:-._:,!. r ?: HOME LOCATION , ':_ <br /> Current Address:33213 Hwy 34 SE <br /> City:Al bany 2 County:Linn State:OR Zip:97322 <br /> Park Name: (if applicable) ❑■ This is a dealer lot or storage facility <br /> 0 This home is being moved to a new location Complete the section below <br /> New Address:8782 Ravena Dr N <br /> City:Salem County:Marion State:OR Zip:97303 <br /> Park Name:(f 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 />