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B s5K-miev of mE ubloctrci cl 7 C) <br /> SECTION 7 NATURE;OF FIONO(dieckalltli apply) <br /> 'EJAAv n t S IZI/V9 a e)wner / te: <br /> e kAgs.0ftgvrthilfkopartyQrnaYer th sorage <br /> sg t fiittast‘Ch o p tus % Trip Permit <br /> ISI. r..by) ce greN <br /> SECTION 2 APPLICANT.INFORMATION (please.print).,. <br /> ❑e Dealer/Seller ❑Lender Escrow/Title Agent ❑Owner/Buyer ❑Legal Representative <br /> Name'J& <br /> Urst,middle,las[) M Homes LLC Phone:541-928.=1471.- <br /> Address:33213 Hwy 34 SE <br /> City:Albany. State:OR ZIP:97322 <br /> Email:Isimon@jandmhomes.com <br /> SECTION 3" HOME INFORMATION(information in bold is required) <br /> Home ID#: IV G"\ OR No Home ID: 0 New Home ❑Out of state home El Leaving County Deed Records <br /> Manufacturer:CMH i J 73 <br /> Model:72TEM16602AH24 Year:2024 <br /> Serial Number(s) HUD Label Number(s)*Required if new home <br /> ALB043704OR ORE565253 <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 sale: <br /> at e o[[cab[e) Sale price: 83355 Includes land: El Yes ❑t No <br /> SECTION 4 DEALER INFORMATION(leave blank if no dealer) <br /> Name:J&M Homes LLC License'#:MSDI 55. <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 underst nd it can be used as evidence in court and is subject to a penalty of perjury. <br /> Signature: (AL <br /> 4 - h0/25-7 Date: <br /> �' <br /> SECTIONS HOME <br /> .. <br /> E LOCATION <br /> Current Address:33213 Hwy 34 SE <br /> City:Albany • County:Linn State:OR Zip:97322 <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:4 Sbir-ley-Ave 1381 .7 <br /> City:Hubbard County:Marion State:OR Zip:97032 <br /> Park Name:(if 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:lsimon@jandmhomes.com <br /> Page 2 <br />