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)Das /10 MhSECTION 1 NATURE OF FILING(check all that apply) <br /> avo , <br /> 0 New home to MHODS ELAddingrar-KM-Netilgtrar 17S--DdBabigok(Daje: <br /> a_Ieltv.d-lawneNatell '4,•adlawch'iNas-fegl`propeTt'y cConverietk storage <br /> -•12-seaitinavesertireo qa_RefehingalszeatiRspert3Pstatus 1=1 Trip Permit <br /> SECTION 2 APPLICANT INFORMATION(please print) <br /> EVillagibr-britheritkince -1;1--OtheNglsale.k.iote): <br /> 0 Dealer/Seller 0 Lender El Escrow/Title Agent 0 Omer/Buyer 0 Legal Representative <br /> Name. <br /> ffirst,middle,last)J&M Homes LLC Phone:541-928-1471 <br /> Address:33213 Hwy 34 SE <br /> city:Albany State:OR LIP:97322 <br /> Email:Isimon@jandmhomes.com <br /> ttOdfiriiiiiiii•iii*ci is <br /> Home ID#: J E.W OR No Home ID: ,-,ral New Home El Out of state home 0 Leaving County Deed Records <br /> Manufacturer:CMH <br /> Model:72DRM28563CH25 Year:2025 <br /> Serial Number(s) HUD Label Number(s)*Required if new home <br /> ALB0439630RA <br /> ALB043963ORB <br /> #ofSections: 2 Sq.footage: 1674 Bedrooms: 3 Bathrooms: 2 <br /> Roofmg type: Architectural Siding type: Cement Lap Heating type: Electric Cooling type: None <br /> Date of sale: <br /> (if applicable) 8/20/24 Sale price: 172770 Includes land: 0 Yes 0 No <br /> SECTION 4 DEALER INtoFtmATIoNjlqdve.btpkifh.Oileqlqr):. : <br /> Name:fflrst,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 understand it can be use,d as evidence in court and is subject to a penalty of perjury. <br /> Signature:(2)170A km164,-) Date: 1/2 7/25 <br /> SECTION I . • • . <br /> Current Address:2445 Pacific Blvd SW <br /> City:Albany County:Linnn 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:10256 Mohawk St NE <br /> City:Silverton County:Marion State:OR Zip:97381 <br /> Park Name: (if applicable) 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 />