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fi4vb kpc.,h,scei-er Rcl 3 E , TefLir6Cr) <br /> SECTION 1 NATURE OF FILING(check all that apply) <br /> D—N r me-8-kttIODS dd em c ner en ttio a e: ) <br /> ems,sale cor ' L4e rage <br /> writ in re e o ' o status ermit <br /> ENTis fav-le in]ritance errs te): <br /> SECTION 2 APPLICANT INFORMATION (please print) <br /> ❑� Dealer/Seller ❑Lender ❑Escrow/Title Agent ❑Owner/Buyer ❑Legal Representative <br /> Name`J&M Homes LLC Phone:503-908-8166 <br /> Psi,middle,last) <br /> Address:15850 S. Pope Lane <br /> City:Oregon City State:OR ZIP:97045 <br /> Email:aspencer@jandmhomes.com <br /> SECTION 3 HOME INFORMATION (information in bold is required) <br /> Home ID#:73£V\J OR No Home ID: Q New Home ❑Out of state home ❑Leaving County Deed Records <br /> Manufacturer:CMH MFG, West Albany CO 1113 6 <br /> Model:DRM483F Year:2024 <br /> Serial Number(s) BUD Label Number(s)*Required if new home <br /> ALB0435340RA ORE565262 <br /> ALB043534ORB ORE565263 <br /> #of Sections: 2 Sq.footage: 1,440 Bedrooms: 3 Bathrooms: 2 <br /> Roofing type: Architectural Siding type: Vertical Wood Heating type: Electirc Cooling type: None <br /> Date of sale: 7/2/2024 Sale price: $145,255.00 Includes land: ❑Yes N No _ ' <br /> (if applicable) <br /> SECTION 4 DEALER INFORMATION (leave blank if no dealer) <br /> Name:J&M Homes LLC License#:MSD-155 <br /> (first,middle,last) <br /> Address:15850 S Pope Lane <br /> City:Oregon City State:OR ZIP:97045 <br /> Emai►: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: yfl15p : }4/' Date:SECTION 5 HOME LOCATION f <br /> Current Address:2445 Pacific Blvd. SW <br /> City:Albany County:Linn State:Or Zip:97321 <br /> e or storage facility <br /> is a dealer lot <br /> Park Name:(if applicable) ❑ g <br /> ❑® This home is being moved to a new location Complete the section below <br /> New Address:11410 Hochspeier Rd. <br /> City:Jefferson County:Marion State:Or Zip:97352 <br /> Park Name: (if applicable) ❑This is a dealer lot or storage facility <br /> Transporter Name:J&M Homes LLC Phone: 503-908-8166 <br /> Address: 15850 S Pope Lane City: Oregon City State: OR <br /> Email:aspencer@jandmhomes.com <br /> Page 2 <br />