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\a1 NAGc.f1on Pc/ St*/ lvr q739 <br /> SECTION 1 NATURE OF FILING(cfieck aII that,aAPIY);;: <br /> calA latitstd 1D,S icilktraNKONerrfolkirrAdenawlier alrf4 i(V : ) _ <br /> VN"HAurfe‘silir rcfnite' age ..._ <br /> IcA82tmiNiaNsittamie ❑i Trip Permit <br /> aer Y Pf ffiet4/Netregiatta: <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:541-928-1471 <br /> (first;middle,last) <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#: OR No Home ID: ❑■ New Home ❑Out of state home ❑Leaving County Deed Records <br /> Manufacturer:CMH t -Dad <br /> Model:72DRM14562AH25 Year:2025 <br /> Serial Numbers) HUD Label Number(s) *Required if new home <br /> ALB044388OR - <br /> #of Sections: 1 - Sq:footage: 756 Bedrooms: 2 Bathrooms: -1 <br /> Roofing type:- Architectural Siding type: Vertical Wood Heating type: Electric. Cooling type: None _- • <br /> - <br /> ..Date of sale'. <br /> japplicable) <br /> 2/16/25 -Sale price: 77606 Includes land: ❑Yes ❑� No <br /> SECTION 4 DEALER INFORMATION (leave blank,if no dealer) <br /> Name:J&M Homes LLC License#:MSD155 <br /> Psi,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 unders- nd it can be used as evidence in court and is subject to a penalty of perjury. <br /> Signature: V/igt(, )& ti Date: 1�y125 <br /> SECTION 5 HOME LOCATION <br /> Current Address:2445 Pacific Blvd SW <br /> City:Albany _ County:Linn State:OR Zip:97321 <br /> Park Name: (f applicable);, ❑This is a dealer lot or storage facility.... <br /> ❑Q This home is being moved to a new location Complete the section below <br /> New Address:12691 Marion Rd SE <br /> City:Turner County:Marion State:OR Zip:97392 <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:Isimon@jandmhomes.com <br /> Page 2 <br />