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• 4 1 ' Tô '5 tnr 5 io Rc 8t , G <br /> ❑ New home to MHODS ❑ Adding or removing a co-owner 0 Demolition(Date: ) <br /> 0 Used home sale 0 Recording as real property 0 Converted to storage <br /> ❑ Security interest change ❑ 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 0 Owner/Buyer ❑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 ZIP:97322 <br /> Email:Isimon@jandmhomes.com <br /> r SECTION 3 " ' F , ,.; A HOME_IN,FORMATION'(Informat on m bold is'regwr'ed), ;`, . . _ ;:,i`f. '._ ` 4 <br /> Home ID#: OR No Home ID: N 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 /> ALB043821ORA - <br /> ALB043821ORB <br /> #of Sections: 2 Sq.footage: 1152 Bedrooms: 3 Bathrooms: 2 <br /> Roofing type: Architectural Siding type: Vertical Wood Heating type: Electric Cooling type: None <br /> Date of sale: 7/7/24 Sale rice: <br /> afapplicable) p 114825 Includes land: 0 Yes ci No <br /> SECTION 4 DEALER:INFORMATION�leav blank if no dealer)> <br /> Name'J&M Homes LLC <br /> first,middle,last) License#:MS D 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 unders d it can be used as evidence in court and is subject to a penalty of perjury. <br /> Signature 3804431Y/ Date: I//2O 2:SECTION 5 . HOME LO..,CATION <br /> Current Address:2445 Pacific Blvd SW <br /> City:Albany County:Linn State:OR Zip:97321 <br /> Park Name:(f applicable) 0 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:4940 Sunnyside SE G 0 <br /> City:Salem County:Marion State:OR Zip:97302 <br /> Park Name:(f applicable) Sunnyside J 0 6; i F 1—I 0 v-Y,e 5 0 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 />