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4q 8L7 G Q7) <br /> ❑ New home to MHODS ❑ Adding or removing a co-owner ❑ Demolition(Date: ) <br /> 0 Used home sale 0 Recording as real property ❑ Converted to storage <br /> ' ❑ Security interest change 0 Removing from real property status 0 Trip Permit <br /> ❑ Transfer by inheritance ❑ Other(please note): <br /> SECTION 2 APPLICANT INFORMATION (please print) <br /> ❑� Dealer/Seller 0 Lender 0 Escrow/Title Agent ❑Owner/Buyer 0 Legal Representative <br /> Name' <br /> (first,middle,last)J&M Homes LLC Phone:541-928-1471 <br /> Address:33213 Hwy 34 SE <br /> City:Albany State:OR GIP:97322 <br /> Email:Isimon@jandmhomes.com <br /> SECTION 3 HOMErINFORMATION,(lnformation m bold.is'requ:red) i fi 1 t` <br /> Home ID#: OR No Home ID: P1 New Home ❑Out of state home ❑Leaving County Deed Records <br /> Manufacturer:CMH <br /> Model:72TEM24483AH24 Year:2024 <br /> Serial Number(s) HUD Label Number(s)*Required if new home <br /> ALB043821 ORA <br /> ALB043821 ORB <br /> #of Sections: 2 Sq.footage: 1152 Bedrooms: 3 Bathrooms: 2 <br /> Roofmg type: Architectural Siding type: Vertical Wood Heating type: Electric Cooling type: None <br /> Date of sale: 7/7/24 Sale rice: <br /> al applicable) p 114825 Includes land: ❑Yes 0 No <br /> ,`::SECTION 4 DEALER INFORMATION tleav�blankifno Beale[)_ _ ; <br /> Name. <br /> psi,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 d it can be used as evidence in court and is subject to a penalty of perjury. <br /> Signature: )&41/9V) Date: !f 2. /2 L� <br /> SECTION 5 =...:HOME.LOCATION K: <br /> Current Address:2445 Pacific Blvd SW <br /> City:Albany County:Linn State:OR Zip:97321 <br /> Park Name:(if applicable) 0 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:4940 Sunnyside SE D <br /> City:Salem County:Marion State:OR Zip:97302 <br /> Park Name: (if applicable) Sunnyside AA 0 b i 1P I—Ij 01 n e 5 ❑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 />