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• <br /> 150 .1-1 ► its0iz sr- , S <br /> NATURE OF FILING check all that a lies <br /> ' . y -c r ' es IP, 4 a•:. ►`rs.�', a P. . D. eo' .-m.' ..• <br /> J k c• t eal - 1 -••o t o - . _• o •r r ❑■ Trip permit gelgaaare <br /> LJ/Qther: <br /> APPLICANT.INFORMATION <br /> i 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: dcallahan@jandmhomes.com <br /> HOME INFORMATION (* required) <br /> Home ID number(if known): DMV X-plate number(if known): <br /> MEW m 5`aJ <br /> ❑Moving in from another state <br /> Has no home ID or X-plate because: ❑Coming out of county deed records <br /> ■❑Other:Brand new home <br /> Manufacturer:CMH Model:72DRM15663AH20 Year:2020 <br /> Manufacturer serial number HUD number <br /> ALB039290OR <br /> *Number of sections:1 *Square footage:990 *Number of bedrooms:2 *Number of bathrooms:2 <br /> *Type of roofing:Architectural *Type of siding:Vertical wood *Heating:Electric *Cooling:None <br /> *Date of sale:2/28/2020. *Sales price:63567 *Includes land: ❑Yes 0 No <br /> DEALER INFORMATION (if no dealer,leave blank) <br /> Dealer name: Dealer license number: Dealer address and phone: <br /> J &M Homes, LLC MSD155 12901 SE 97th Ave. #100 <br /> Clackamas, OR 97015 <br /> 503-908-8166 <br /> *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 I understand it is <br /> made for use as evidence in court and is subject to penalty for perjury. <br /> Dealer name (print): Dealer signature: Date: q /l <br /> J & M Homes, LLC CPU, 7///z C) <br /> TRANSPORTER INFORMATION ('if not moving, leave blank) <br /> Transporter name: Transporter address and phone: <br /> J &M Homes, LLC 12901 SE 97th Ave.#100 <br /> Clackamas, OR 97015 <br /> 503-908-8166 <br /> 440-2952(7/17/COM) Page 2 <br />