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S , �- <br /> SECTION 1 ; .NATURE OF FILING(iheckallthatapply) <br /> owner LVtea'io O ) <br /> Ll 01110Me co rty -ZNIVerDuk6nLoge <br /> (N/VIX2uil'N.Ptg Stl3inge Zi eftinarzikral.poperty„status • Trip Permit <br /> Z.82 psfefay l ik atance et hu ts..): <br /> SECTION 2 APPLICANT,INFORMATION (please:,pnnt) <br /> ■❑Dealer/Seller ❑Lender ❑Escrow/Title Agent ❑Owner/Buyer ❑Legal Representative <br /> Name`J&M .Homes LLC Phone:541-928-147.1 . <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 a , r= <br /> _,..,__. ,,, _, �r. HOME INFORMATION (infprmation,in,bold is required) _ `' _° N <br /> Home ID#: V E OR No.Home ID: 0 New Home ❑Out of state home ❑Leaving County Deed Records <br /> Manufacturer:CMH 60741 '7 <br /> Model:72DRM28443AH23 Year:2023 <br /> Serial Number(s) HUD Label Number(s)*Required if new home <br /> ALB0428920RA <br /> ALB042892ORB <br /> #of Sections: 2 - Sq.footage: 1620 Bedrooms: 3 . Bathrooms: 2 <br /> Roofmg type: Architectural Siding type: Stained Lap Heating type: Electric Cooling type: Heat Pump <br /> Date of sale: 8/13/23 Sale price: 206115 Includes land: ❑Yes ❑■ No <br /> ajapplicable) <br /> SECTION 4 Y DEALER INFORMATION..(leaveblankifnodealer)' <br /> Name:J&M Homes LLC License#:MSD155 <br /> Oirst,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,seburity 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 sed'as evidence in court and is subject to a penalty of perjury. <br /> Signature: k. Date: 52 /2 <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) ❑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:230 Meyer St S <br /> City:Detroit County:Marion State:OR Zip:97342 <br /> Park Name:(if applicable) ❑This is a dealer lot or storage facility <br /> Transporter Name:J&M Homes LLC Phone: 541-928-14.71 . <br /> Address:33213 Hwy 34 SE City: Albany State: OR <br /> Email:Isimon@jandmhomes.com <br /> Page 2 <br />