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(671B4 Ave Scul On—) <br /> SECTION 1 , NATURE OF riONO:(check'all that apply) - <br /> Ni4eahcavta3/16IDS I=1 AkiNg-olicang1/4a,cct9vvner tgagaifikrtlAte: ) <br /> D fterkanae-siale El VedkraessIgreel1kcprt) y D 6ContivstMtest61.-age <br /> El gekeltrtitaustehOge &thalsalftefitzkr.tcoportntatus <br /> 1:1 Trip Permit <br /> ki,,dpfoctilaecitalke 0Vir arid,aseeNuotE): <br /> :;-SECTION , : • •'• APPLICANT INFORMATION (0 4s print) <br /> II Dealer/Seller D Lender Escrow/Tide Agent 0 Owner/Buyer D Legal Representative <br /> Name. <br /> (first,middle, J&M Homes LLC Phone:541-928-147 1 <br /> Address:33213 Hwy 34 SE <br /> city:Albany State:OR II P:97322 <br /> Email:isimon@jandmhomes.com <br /> SECTION 3 HOME INFORMATION(information rn bohi is requid) <br /> Home ID#:KJV OR No Home ID: jilNewHome 0 Out of state home D Leaving County Deed Records <br /> Manufacturer:CM H (01. 3 6 3 <br /> Model:72ING24362B H26 Year:2026 <br /> Serial Number(s) HUD Label Number(s)*Required if new home <br /> ALB0450340RA 0RE571288 <br /> ALB045034ORB ORE571289 <br /> #of Sections: 2 Sq.footage:. 1056 Bedrooms: 2 Bathrooms: 2 <br /> Roofing type: Metal • Siding type: Vertical Wood Heating type: Electric Cooling type: Heat Pump <br /> DatOfe of salapplicablee: 2/13/26 Sale price: 157126 Includes land: ElYes It No <br /> ) <br /> SECTION <br /> (first,middle,middle,Iasi).J&M Homes LLC License#:MSD155 <br /> Address:15850 S Pope Lane <br /> City:Oregon City State:OR LIP: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 jtJ 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:,*AA , 'jJjvyrJDate:3/51/2(2 <br /> SECTION 5 HOME 001:100: <br /> Current Address:33213 Hwy 34 SE <br /> City:Albany County:Linn State:OR Zip:97321 <br /> Park Name: (([applicable) <br /> This is a dealer lot or storage facility <br /> 1=I This home is being moved to a n4 location Complete the section below <br /> New Address:6184 31st Ave <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 />