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6e.,4 Rd I-) Quay d <br /> SECTION 1NATURE OF.FILING(check all that apply) <br /> S...Ani ;lg.° trCIN.v.ing-a-ca,e151tn r 'Nfg-'15Ni relttiMegfe <br /> • <br /> KI-41a.Chcer-341e ELR'eawiingclx4sop11—C-elnited:Ltes-turV— <br /> INkSeNdeinter.eat-ciNge teffOiNn e jatli-o-pFty-status II Trip Permit <br /> atiVradtrrhg.irthlvitaitce 5-09ftr.4/intse-faae): <br /> SECTION 2 4001:1tAr4tiisOO)IMAtION (000ptitit):',.. <br /> N Dealer/Seller E Lender 0 Escrow/Title Agent 0 Owner/Buyer 0 Legal Representative <br /> Name:J&M Homes LLC Phone: <br /> (first,midcll /as 541-928-1471 <br /> Address:33213 Hwy 34 SE <br /> City:Albany State:OR ZIP:97322 <br /> Email:lsimon@jandmhomes.com <br /> SECTION 3 HOME INFORMATION (infomation in bold is required) <br /> Home ID#: OR No Home ID: N New Home 111 Out of state home D Leaving County Deed Records <br /> Manufacturer:CMH CO 61 cB(to <br /> Model:72TEM16602AH23 Year:2023 <br /> Serial Number(s) HUD Label Number(s) *Required if new home <br /> ALB042648OR NTA2182302 <br /> #of Sections: 1 Sq.footage: 900 Bedrooms: 2 Bathrooms: 2 <br /> Roofing type: Architectural Siding type: Vertical Wood Heating type: Electric Cooling type: None - - <br /> Date of sle• 4/10/24 Sate price: 76855 Includes land: Eyes N No <br /> SECTION 4 - DEALER afapplicable) <br /> INFORMATION(leave blank if ricid6aler) <br /> • <br /> Name.(first,middle,lcist)J&M Homes LLC License#:MSD155 • <br /> Address:15850 S Pope Lane <br /> City:Oregon City State:OR ZIP:97045 <br /> 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 used as evidence in court and is subject to a penalty of perjury. <br /> Signature: :)5(9/11_, Auyab'n Date: P/2 9/24/ <br /> 1.5 :cTIOP1 . HOME LOCATION ••• . • - <br /> Current Address:33213 Hwy 34 SE <br /> City:Albany County:Linn State:OR Zip:97322 <br /> Park Name:(if applicable) 0 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:19290 Fobert Rd <br /> City:Hubbard County:Marion • State:OR Zip:97032 <br /> Park Name: (if 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:lsimon@jandmhomes.com <br /> Page 2 <br /> _ . <br />