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q Rcu rylra ut) Ltp 3 , )—/Gt ce_v?"' <br /> 111 n -c t in , 14‘2v.et.zafsliipE o tn 'ate • me • •on: <br /> • o s re .1...•rt S. •in••"n! m 9 .1 rt s [-.1 Trip permit UNarktegerdlb-&+arage <br /> her: <br /> APPLICANTANFORMATION:- <br /> El Dealer/seller Lender 111 Escrow/title agent Owner/buyer III 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 /> • <br /> HOMElNFORMATlON (* <br /> - <br /> Home ID number(if known): DMV X-plate number(if known): <br /> 1\1 CAA/ try\ 35 5 5 <br /> Moving in from another state <br /> Has no home ID or X-plate because: Coming out of county deed records <br /> El Other: <br /> Manufacturer:CMH Manufacturing, Hermiston Model:2017 Columbia River Year:2020 <br /> Manufacturer serial number HUD number <br /> HER0319600RA <br /> HERO3f9600RB <br /> *Number of sections:2 *Square footage: 1,512 *Number of bedrooms:2 *Number of bathrooms:2 <br /> *Type of roofing:Composition *Type of siding:Wood *Heating:Electric *Cooling:None <br /> *Date of sale: *Sales price: *Includes land: Yes I]No <br /> DEALERlNFQRMAT!ON (tfn dealer, leave blank) <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 /> ['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): De ler signature: Date: <br /> J & M Homes LLC <br /> Transporter name: Transporter address and phone: <br /> J &M Homes, LLC 12901 SE 97TH Ave#100 Clackamas, OR 97015 <br /> 440-2952(7/17/COM) Page 2 <br />