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e-- <br /> (1) 1 ck..\/ cd1 st w <br /> n ct D92 <br /> SECTION 1 NATURE OF FILING(check all that apply) <br /> KrtleWhrmete-DaltiP—S- er tt/merktio..(Q.og... ) <br /> GRoUgezklatVeNalev 1211-NAliit,tarki‘pr615aFty qic.90(25e01 eAstcrage <br /> atus 0 Trip Permit <br /> toe 1/N0%A efftx& <br /> SECTION 2 APPLICANT INFORMATION (please print) <br /> , EI Dealer/Seller Lender 0 Escrow/Title Agent Owner/Buyer 0 Legal Representative - <br /> (fir <br /> •J&M Homes LLC st,middle,last) Phone:541-928-1471 <br /> , <br /> Address:33213 Hwy 34 SE <br /> City:Albany State:OR ZIP:97322 <br /> Email:Isimon@jandmhomes.corn <br /> SECTION,3 HOME INFORMATION (information in bold is required) <br /> Home ID#: OR No Home ID: 0 New I Iome U Out of state home 111 Leaving County Deed Records <br /> Manufacturer:CM H (at)-7 f <br /> Model:72ING42603AH23 Year:2023 <br /> Serial Number(s) HUD Label Number(s)*Required if new home <br /> ALB0423940RA NTA2163451 <br /> ALB0423940 RB NTA2163452 <br /> ALB0423940RC NTA2163453 <br /> #of Sections: 3 - Sq.footage: 2360 Bedrooms: 3 Bathrooms: 3-- - - <br /> • <br /> Roofing type - Architectural Siding type: Vertical Wood Heating type: Electric Cooling type: None---. <br /> , <br /> :13ate d-sale: 2/14/23 Sale price: 236918 Includes land: L1Yes tNo <br /> (7f applicable) <br /> SECTION.4 DEALER INFORMATION (leave blank if no dealer) <br /> Naine• <br /> (first,middle,last)•J&M Homes LLC License#:MSD155 <br /> • Address:15850 S Pope Lane <br /> City:Oregon City State:OR ZIP:97045 <br /> Email:dasla@jandmhomes.com Phone:503-908-8166 <br /> I hereby declare 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 or my interest in it. The information listed is true to the best of my knowledge and <br /> belief,and I unders yd it can be used as evidence in court and is subject to a penalty of perjury. <br /> Signature: 0)1/19/Y) Date:5/p?,2/73 <br /> SECTION 5 HOME LOCATION <br /> Current Address:2445 Pacific Blvd SW <br /> City:Albany County:Linn State:OR Zip:97321 <br /> Park Name: (if applicable) El This is a dealer lot or stdage facility <br /> „El This home is being moved to a new location Complete the section below <br /> New Address:6217 Stayton Rd SE <br /> City:-Turner County:Marion State:OR Zip:97392 <br /> Park Name: (( applicable) E This is a dealer lot or storage facility <br /> Transporter Name:J&M Homes LLC Phone: 541-928-1471 <br /> Address:33213 Hwy 34 SE City: Albany State: OR <br /> Email: Isimon@jandmhomes.com <br /> Page 2 <br />