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<br /> 0 Dealer/seller ❑ Lender ❑Escrow/title agent ❑ Owner/buyer ❑ Legal representative
<br /> Name:J&M Homes, LLC
<br /> Address(including city,state, and ZIP):12901 SE 97th Ave Suite 100 Clackamas, OR 97015
<br /> Phone:503-908-8166
<br /> Email:apowell@yahoo.com
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<br /> Home ID number(if known): DMV X-plate number(if known):
<br /> rr135-14,P
<br /> ❑Moving in from another state
<br /> Has no home ID or X-plate because: ❑Coming out of county deed records
<br /> •
<br /> ['Other:
<br /> Manufacturer:CMH MANUFACTURING WEST Model:DRM482F Year:2019
<br /> Manufacturer serial number HUD number
<br /> ALBO38604ORA
<br /> ALB038604OR6
<br /> *Number of sections:2 *Square footage:1296 *Number of bedrooms:3 *Number of bathrooms:2
<br /> *Type of roofing:COMP *Type of siding:WOOD *Heating:ELEC *Cooling:NO
<br /> *Date of sale:03/29/2019 *Sales price:$75,256 *Includes land:❑Yes 0 Noy
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<br /> Dealer name: Dealer license number: Dealer address and phone:
<br /> J&M HOMES LLC MSD155 12901 SE 97TH AVE SUITE 100
<br /> CLACKAMAS, OR 97015
<br /> Li 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.
<br /> I hereby declare that the above statement is true to the hest of my knowledge and belief,and that I understand it is
<br /> made for use as evidence in court and is subject to penalty for perjury.
<br /> Dealer name(print): Dealef igna r : 6' Date:
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<br /> Transporter name: Transporter address and phone:
<br /> 440-2952(7/17/COM) Page 2
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