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, . <br /> , a <br /> 'D-3 A Rive r Rd /uE. 84p / <br /> ....* 4.. - <br /> a Le i <br /> SECTION 1 NATURE OF FILING (check all that apply) <br /> L1"c kduaeltoM4RR'9DS 1dflt}pratuew Aber t1D t ) • <br /> ®i 9ed►henuuttte rty e s e' <br /> 1;2l15g ' Allteltakcll ge r ritrVtttus 0 Trip Permit <br /> SECTION 2 ' ' APPLICANT INFORMATION (please print) <br /> • . N Dealer/Seller ❑Lender ❑Escrow/Title Agent ❑Owner/Buyer ❑Legal Representative . . <br /> Name:JkcM Homes LLC Phone:503-908-8166 <br /> • (first,middle,last) <br /> Address:15850 S. Pope Lane <br /> City:Oregon City State:OR ZIP:97045. <br /> Email:aspencer@jandmhomes.com <br /> SECTION 3... HOME INFORMATION (information in bold is required) <br /> Home ID#: OR No Home ID: Q New Home ❑Out of state home ❑Leaving County Deed Records <br /> Manufacturer:CMH MFG, West Albany 60(j-q I It, <br /> Model:Tempo- Under Pressure Year:2024 <br /> Serial Number(s) HUD Label Number(s) *Required if new home <br /> ALB0430960RA NTA2239860 <br /> ALB043096ORB NTA2239861 ' <br /> #ofSections: 2 Sq.footage: 1,296 Bedrooms: 3 Bathrooms:, 2 • <br /> Roofing type: Architectural Siding type: Vertical Wood Heating type: Electric Cooling type: None <br /> Date of sale: rice: 131 402.00 Includes land: ❑Yes ® No <br /> afapplicable) 1/3/2024 Sale p <br /> SECTION 4 DEALER INFORMATION (leave blank if no dealer) ' <br /> Name: <br /> License#: - <br /> (first,middle last J&M Homes LLC MSD 155 <br /> rr > <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 understand it can be used as evidence in court and is subject to a penalty of perjury. <br /> Signature:G 5pem 0 j,4- Date: 4' i-`,I,,' 9 (�,-(' <br /> SECTION 5 : 1_ ' ' HOME LOCATION I ,u` l i/ f <br /> Current Address:2445 SW Pacific Blvd. <br /> City:Albany County:Linn State:Or Zip:97321 <br /> Park Name: (if applicable) ❑This is a dealer lot or storage facility <br /> ]This home is being moved to a new location Complete the section below <br /> New Address:22314 River Rd. NE#4 <br /> City:St. Paul County:Marion State:Or Zip:97137 <br /> Park Name: (if applicable) 0 This is a dealer lot or storage facility • <br /> Transporter Name:J&M Homes LLC Phone: 503-908-8166 <br /> Address: 15850 S Pope Lane City: Oregon City State: OR <br /> Email:aspencer@jandmhomes.com <br /> Page 2 , <br />