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tio."‘ \ cluo00X A\Je , ) clarvhci <br /> an ,-cur . '' - est U :- • . ~'shi• ■ Demolition Date : :- -• ion: <br /> • 'e•• in:as . •r••erty 1 R-- o r•u -a :':•er •atus ❑Trip permit to storage <br /> ther <br /> } <br /> s 4 APPLICANT IfVFO'RMAT1O�N y <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:tmelchior@jandmhomes.com <br /> %3 Gri. a ' _„F.��.,Ei..k :.:_q`�...i.� _. ��.. .. _,�,a s:......d)u., ,,,, „ ..w..�. .._• �_, __.__..F rF.fh xu-.,,.r s_•r...�' ,+.r_.. .. __as-€aR.+ <br /> Home ID number(if known): DMV X-plate number(if known : <br /> KIEV 3511 1 <br /> ❑Moving in from another state <br /> Has no home ID or X-plate because: ❑ Coming out of county deed records <br /> ❑0 Other:New Home <br /> Manufacturer:CMH Manufacturing, Golden West Model:DRM561 M Year:2020 <br /> Manufacturer,serial number HUD number <br /> ALB0396900RA <br /> *Number of sections:1 *Square footage:756 *Number of bedrooms:1 *Number of bathrooms:2 <br /> *Type of roofing:Composition *Type of siding:Wood *Heating:Electric *Cooling:None <br /> *Date of sale:June 11, 2020 *Sales price:$67,775.00 *Includes land: ❑Yes ❑� No <br /> DEALER INFORMATION 3 if,,notdealer,,Iieavetblank) 4 <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 theiabove 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: <br /> J & MHomes, LLCniympvy .),vio ),-p <br /> ' �, T=RANS;P�ORTER INFORMATION,(if npt�moving,4leav&blank) t� <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 />