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4_` <br /> TLACLOO <br /> U <br /> Co Carr) - C4 N �� roe <br /> NATURE;'OF''FiLING r(check alhthat,applies) <br /> ivitc <br /> h n c it ' rE viNs rs ' P& ►`- o ' '41 ► - . •- . ';i <br /> al�lfuc 1 a , a -t tsut9vci� yl yy r e l r t S1 ❑■ Trip permit [ttstf�leL�e�i[ll;�e <br /> :• '� r ti ` ,x .:� APPLICANT=INFORM�ATION� _:_' .r{ . . , , .,Y.��'3`�` . .: .x..4`+ <br /> ❑■ 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 #100,Clackamas, OR 97015 <br /> Phone:503-908-8166 <br /> Email:bbaxter@jandmhomes.com <br /> F ' HOIVIS"INFORMATION1'(*cregtair'ed) '` :r '...x s.. . {.., i <br /> Horne ID number(if known): DMV X-plate number(iifknown): <br /> ❑ Moving in from another state <br /> Has no home ID or X;plate because: ❑Coming out of county deed records <br /> ❑Other: <br /> Manufacturer:CMH Manufacturing West Albany Model:DRM561F Year:2019 <br /> Manufacturer serial number HUD number <br /> ALB0386830RA <br /> ALB038683ORB <br /> `Number of sections:2 *Square footage:1512 *Number of bedrooms:3 *Number of bathrooms:2 <br /> *Type of roofing:Composition *Type of siding:Vertical Wood *Heating:Electric *Cooling:None. <br /> *Date of sale:9/10/2019 *Sales price:83,755.00 *Includes land:❑Yes El No <br /> 'DEALERINFORMATION (lf no dealer, Ieavedblanl) r <br /> F .. ..._-r...n _ ,-. .i ,. �•.Y>.. -, .. _.. <br /> Dealer name: Dealer license number: Dealer address and phone: <br /> J & M Homes, LLC MSD-155 12901 SE 97th Ave #100 <br /> Clackamas,OR 97015 <br /> 503-908-8166 <br /> Q 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 best of my knowledge and belief,and that 1 understand it is <br /> made for use as evidence in court and is subject to penalty for perjury. <br /> Dealer name (print): D le sign tuce: D te: <br /> J & M Homes,LLC M 1111 I I1I�111 <br /> •• <br /> {„ TRAN:806FT;EFON FORMATIONt(if;fib*niouing,aleaveAblank), <br /> Transporter name: Transporter address and phone: <br /> J &M Homes, LLC 12901 SE 97TH Ave.#100 Clackamas, OR 97015 <br /> 440-2952(7/17ICOM) Page 2 <br />