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) 3 B I Wed- V e C- Ii So \'e <br /> 'SEC710N:-1 : '`- .. NATURE'OF.FILING(checkallthatapply) •I. ' <br /> 0 New home to MHODS ❑ r ❑ n '' ate• ) <br /> ❑ tUSedtl la*,et- ❑ xmotiog‘srealimpprty 0 edvertbd16-storage <br /> 0 Security interest change ❑,\&c�lzpiglfriartijrap®rty-status ❑i• Trip Permit <br /> ❑ Vflut§fortriultexitantei ❑ Q hk(1&ascnote): <br /> ,SECTION..;: ::': APPLICANT:INFORM. ATION tPlease. rint .;.. ,.,y,, ,. ' . <br /> 0 Dealer/Seller " 0 Lender ❑Escrow/Title Agent 0 Owner/Buyer 0 Legal Representative <br /> first,middlNe,lasame:t)21 St Mortgage Corporation e Cor oration Phone:800-955-0021x2945 <br /> Address:620 Market Street, Suite 100 <br /> City:Knoxville State:TN ZIP:37902 <br /> Email: <br /> SECTION 3. .:HOME:INFORM ;.,:,.:_;,.::: <br /> = '� =��° ATION:thformatton to bold ts_re rred ---='� <br /> Home ID#: i'V FVJ OR No Home ID: Q New Home ❑Out of state home'❑Leaving County Deed Records <br /> Manufacturer:CMH (e 1 3 ( 31 <br /> Model:721NG42603AH26 Year:2026 . <br /> Serial Number(s) IHUD Label Number(s)*Required if new home <br /> ALB0448990RA ORE571028 <br /> ALB0448990RB ORE571029 <br /> ALB0448990RC ORE571030 <br /> #of Sections: 3 Sq.footage: 2360 Bedrooms: 4 Bathrooms: 3 <br /> Roofing type: Architectural Siding type: Vertical Wood I Heating type: Electric Cooling type: None <br /> Date of sale: 12/29/25 Sale price: 239780 Includes land: ❑Yes 0 No <br /> ajapplicable) <br /> SECTION 4 <'': :: :: '.,':_.:DEALER INFORMATION:(leave_blarikifnodealet):.`__ : r:':::;:-..:=::;_..:..:':' 6.:..;°,.' _ .,_.;,. ` ,:;, <br /> Name:J&M Homes LLC License#:MSD155 <br /> first,middle,last) <br /> Address:15850 S Pope Lane <br /> City:Oregon City State:OR LI':97045 <br /> Email:dasla@jandmhomes.com I 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 enders it can be <br /> used as evidence in court and is subject to a penalty of perjury. <br /> Signature: �ild <br /> . Date: 3l3/J..26 <br /> SECTIONS HOME LOCA •TION' <br /> -... . <br /> CATION <br /> Current Address:33213 Hwy 34 SE <br /> City:Albany County:Linn State:OR Zip:97322 <br /> Park Name:(if applicable) 0 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:1381 W View Ct NE <br /> City:Salem County:Marion State:OR Zip:97317 <br /> Park Name: (if 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 />