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• <br /> a- 357 I Meg uocvrq <br /> SECTION 1 NATURE(PP;014Nd(cilqck4ll that apply) 7';•: <br /> 1igkbefkit6NUPDS INI-4,1kIja(okspinaglervner rclslate: ) <br /> t:Nont‘k!)e in r NI\GotAtaill5-sturge <br /> 'ciNesxfflOirstejegtvjuJ2ge Iralvie-status 1=1 Trip Permit <br /> SECTION 2 APPLICANT INFORMATION (please print) <br /> tAT8cafArsb)utikutfince fa_gatrr-Olease-note): <br /> El Dealer/Seller El Lender 1=I Escrow/Title Agent El Owner/Buyer D Legal Representative <br /> Name. <br /> •(first,middle J&M Homes LLC Phone:541-928-1471 <br /> ,last) <br /> Address:33213 Hwy 34 SE <br /> city:Albany State:OR ZIP:97322 <br /> Email:Isimon@jandmhomes.com <br /> SECTION 3 aoME INFORMATION (lnfoñiatin in bold i required) - <br /> Home ID#: \X.) OR No Home ID: New Home Out of state home El Leaving County Deed Records <br /> Manufacturer:CMH 620 /39-6-1 <br /> Model:72CRM28483AH24 Year:2024 <br /> Serial Number(s) HUD Label Number(s)*Required if new home <br /> ALB0432150RASC <br /> ALB043215ORBSC <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: LI I n/.40/20 n Sale price: 125229 Includes land: Yes El No <br /> SECTION 4 afapplicab4 <br /> •••`.::.:D'EAL:Eit INFORMATION:(re :614 k if no.dealer) <br /> Name: !AAA <br /> alrst,middle,last Homes LLC License#:MSD155 <br /> • Ackiress:15850 S Pope Lane <br /> • City:Oregon City State:OR ZIP:97045 <br /> Email:däsla@jándmhomes.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 d it can be used as evidence in court and is subject to a penalty of perjury. <br /> Signature: Oa, Aoryikr) Date: 5/240/22/ <br /> SECTION 5 HOME LOCATION <br /> Current Address:2445 Pacific Blvd SW <br /> City:Albany County:Linn State:OR Zip:97321 <br /> Park Name:(if applicable) El 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:,23571 Meadow Dr NE <br /> City:Aurora County:Marion State:OR Zip:97002 <br /> Park Name:(if applicable) El 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 />