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a•a � ► � <br /> R‘i vex Rd NE, &L PtA. 1 <br /> SECTION 1 NATURE OF FILING (check all that apply) <br /> FailiikleVAVAINSVP Als.1441> Pl g• per 6TALA ) <br /> CAABNAINzaale i t eity ISIAQaptexteaLoskerrtige <br /> rt t t SA.eilat ee Reljy6britainuifteirkprt kOtr4us 0 Trip Permit <br /> ,SECTION 2 APPLICANT INFORMATION (please print) <br /> D Dealer/Seller ❑Lender ❑Escrow/Title Agent ❑Owner/Buyer ❑Legal Representative <br /> • Name:Urst,middle,last)J&M Homes LLC Phone:503-908-8.166 <br /> Address:15850 S. Pope Lane <br /> City:Oregon City • State:OR ZIP:97045 <br /> gmaii:aspencer@jandmhomes.com <br /> SECTION.3 , HOME INFORMATION (information in bold is required) <br /> I-Iome ID#: OR No Home ID: 0 New I-lame ❑ Out of state home ❑Leaving County Deed Records <br /> Manufacturer:CMH MFG, West Albany c •7 <br /> Model:DRM562F U Year:2024 <br /> Serial Number(s) HUD Label Number(s)*Required if new home. <br /> • ALB0430950RA NTA2239855 <br /> ALB043095ORB NTA2239856 • <br /> • #of Sections: 2 Sq.footage: 1,512 Bedrooms: 3 Bathrooms: 2 • <br /> Roofing type: Architectural Siding type: Vertical Wood Heating type: Electric Cooling type: None <br /> Date ofsale: 1/3/2024 Sale price: $158,255.00 Includes land: ❑Yes 0 No • <br /> (japplicable) <br /> -SECTION 4. DEALER INFORMATION(leave blank if no dealer) <br /> Name:(first,middle,last)J&M Homes LLC License#:MSD-155 <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 understandt it can be used as evidence in court and is subject to a penalty of perjury. <br /> Signature:(1"�J lg 5pD Al ���A,— Date: 11//0/0),(4 <br /> SECTIONS • 1 P I I/ `�✓I HOME LOCATION i.. <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 /> 0 This home is being moved to a new location Complete the section below <br /> New Address:22312 River Rd. NE <br /> City:St. Paul County:Marion , State:Or Zip:97137 <br /> Park Name: (if applicable) ❑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 />