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1344 -11 fie -r-a n wy 9 Es � <br /> o y 9 �, shc') 9 '35 <br /> .;SECTION 7 NATURE OF FILING-(check'.all that apply) ; F <br /> ❑ New home to MHODS 0 Adding or removing a co-owner ❑ Demolition(Date: ) <br /> • ❑ Used home sale El Recording as real property ❑ Converted to storage <br /> El Security interest change ❑ Removing from real property status 0 "Trip Permit .•. <br /> 0 Transfer by inheritance • 0 Other(please note): <br /> ...._. <br /> 'SECTION 2 .` APPLICANT�INFORMATION (pleasFepnnt)_ ' 3 !"< * - <br /> y ❑Leal <br /> .. ❑� Dealer/Seller 0 Lender ❑Escrow/Title Agent 0 Owner/Buyer er gal Representative <br /> Name:- J&M Homes LLC , phone:541-928-1471 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.(n`formation in bold is required) <br /> Home ID#: OR No Home ID: 0 New Home ❑Out of state home ❑Leaving County Deed Records <br /> Manufacturer:CMH , 60 11 33,- , <br /> Model:721NG42684AH25 Year:2025 <br /> Serial Number(s) HUD Label Number(s)*Required if new home:' <br /> ALB0444440RA "- <br /> ALB044444ORB <br /> ALB0444440RC,ALB044444ORD - <br /> •- #of Sections: 4 "— • • Sq:footage: 3018 Bedrooms: 5 - Bathrooms: 3-- <br /> -" Roofmtype: Architectural Siding •'"•g type: Vertical Wood Heating type: Electric- Cooling type: None "- ,- <br /> i.._ Date:ofsale: - .-- <br /> (1f applicable) <br /> 3/7/25 " Sale price: 285832 Includes land: ❑Yes O No SECTION 4 DEALER:INFORMATION(leave blank if no dealer), „ , <br /> Name: _ <br /> (first,middle,last) <br /> ,Homes LLC License#:MSD 155 <br /> J&M <br /> • Address:15850 S Pope Lane • . . _.._.. <br /> City:Oregon City State:OR . . Zie: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 it can be used as evidence in court and is subject to a penalty of perjury. <br /> Signature: Date: /Z.,40,5. <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) <br /> ❑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:13471 Jefferson Hwy 99E SE <br /> City:Jefferson County:Marion State:OR Zip:97352 <br /> Park Name: (f 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:Isimon@jandmhomes.com <br /> Page 2 <br />