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. . <br /> • . <br /> , <br /> i b7 a-7 S-i-cw-ror‘ R 0\ 8E, , ,Attyy,60 , ) 6 . <br /> SECTION 1, , ,.. ' . - . NATURE OF FILING(check all that apply) <br /> . . , <br /> M New home to MHODS Neloa,eatr.ea.,i104oiler LIA5enati4(19ete:. ) <br /> IS2Misaiimotive 1 1 . - • 1;;Pton rieft3fiikt,04-e- ' <br /> . . <br /> 1 , g tus El Trip Permit <br /> ra r4erce &Vok44)9.1.ietseinso): <br /> ,SECTION 2 . . '._ . " :7: APPLICANT.INFORMATION (please Print) <br /> Ef Dealer/Seller E]Lender 0 Escrow/Title Agent 0 Owner/Buyer 0 Legal Representative <br /> Name. <br /> J&M•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:aspenber@jandmhomes.com . <br /> . . <br /> SECTION 3 s,. _ , . ' HOME INFORMATION (information in bold Is required) <br /> Home ID#: N EA,\J OR No Home ID: E New Home 0 Out of state home 0 Leaving County Deed Records <br /> • <br /> Manufacturer:CMH MFG, West Albany <br /> . . <br /> Model:Tempo-Shout . Year:2024 <br /> Serial Number(s) HUD Label Number(s)*Required if new home, <br /> HER0344120RA . . <br /> HER0344120RA <br /> #ofSections: 2 _ Sq.footage: 1,493 Bedrooms: 3 Bathrooms: 2 . <br /> Roofing type: Architectural Siding type: Vertical Wood Heating type: Electric . Cooling type: None <br /> Date of sale: 9/14/2024 Sale price: $129,405.00 Includes land: 0 Yes 0 No . . <br /> (Ifapplicable) <br /> ',SECTION"4':. ;'' : : ::— : .:'1 —DEALER INFORMATION(leave blank if no dealer) <br /> ' Name. <br /> (first,middle,Iasi)J&M Homes LLC License th 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 understand it can be used as evidence in court and is subject to a penalty of perjury. . <br /> Signature: rryi 1 j 5 pejn el.*. Date:. 1111,12 O)._1.1 <br /> : <br /> SECTION , HOME LOCATION- . . <br /> Current Address:400 W Elm • <br /> City:Hermiston County:Umatilla State:Or Zip:97838 <br /> Park Name:(( applicable) D This is a dealer lot or storage facility <br /> El This home is being moved to a new location Complete the section below <br /> New Address:10727 Stayton Rd. SE _ .. <br /> City:Aumsville County:Marion State:Or Zip:97325 <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 /> '---- <br /> Page 2 <br /> . . <br />