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tL5a Cio o <br /> SECTION 1 ;' NATUREtiOF FILING{check-all that apply) <br /> LAdc' g re o co- er u n .'„ on,-rr ate � ) <br /> [.JO++JaR m sSie a RsetST 'n e LW rty e orage <br /> ec m phenge R v rea perry tus Trip Permit <br /> e ELQ.therZtiase ote <br /> ,SECTION 2 APPLICANT INFORMATION(please print) f.T <br /> Dealer/Seller ❑Lender ❑Escrow/Title Agent ❑Owner/Buyer ❑Legal Representative <br /> Name:J&M Homes LLC Phone:541-928-1471 <br /> (first,middle,last) <br /> Address:33213 Hwy 34 SE <br /> City:Albany State:OR ZIP:97322 <br /> Email:lsimon@jandmhomes.com <br /> 'SECTION 3`' .,. HOME INFORMATION,(information in bold is required) ,{; <br /> Home ID#: L W OR No Home ID: ®❑New Home ❑Out of state home El Leaving County Deed Records <br /> Manufacturer:CMH 61 1. f�. (c <br /> Model:72DRM28563BH24 r Year:2024 v L <br /> Serial Number(s) HUD Label Number(s)*Required if new home <br /> ALB0438150RA <br /> ALB043815ORB <br /> #of Sections: 2 - Sq.footage: 1512 Bedrooms: 3 Bathrooms: 2 <br /> Roofing type: Architectural Siding type: Cement Lap Heating type: Electric Cooling type: None <br /> Date of sale: 5/1 i24,. Sale price: <br /> (Ifappticabte) Pi 162786 Includes land: ❑yes 0 No <br /> SECTION 4 DEALER INFORMATION(leave blank,ifno dealer) <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 understand it can be used as evidence in court and is subject to a penalty of perjury. <br /> Signature: ?, jajmsben Date <br /> SECTIONS :: 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 /> 0 This home is being moved to a new location Complete the section below <br /> New Address:11556 McClellan Lane SE <br /> City:Aumsville County:Marion State:OR Zip:97325 <br /> Park Name:(f applicable) ❑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 />