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x-4-on. <br /> PIa S [en-, <br /> SECTION 1 NATURE OF FILING(check all that apply) <br /> 14W i e S i er <br /> ft"Laiehlef a e a y n t et erAtefage <br /> a tifi i 'eS¢st ltare o r r is Q Trip Permit <br /> r Ale): <br /> SECTION 2 • APPLICANT INFORMATION(please print) - <br /> 0 Dealer/Seller ❑Lender ❑Escrow/Title Agent ❑Owner/Buyer ❑Legal Representative <br /> •Name:Urs[,middle,last)J&M Homes LLC Phone:503-908-8166 <br /> Address::15850 S. Pope Lane <br /> City:Oregon_City State:OR ZIP:97045 <br /> Email:aspencer@jandmhomes.com <br /> SECTION 3 HOME INFORMATION (information in bold is required) <br /> Home ID#: OR No Home ID: ®❑New Home ❑Out of state home ❑Leaving County Deed Records <br /> Manufacturer:CMH MFG, West Albany 6,1 '34 04 <br /> Model:ING362A Year:2025 <br /> • • Serial Number(s) HUD Label Number(s)*Required if new home <br /> ALB0443390RA ORE568157 <br /> • ALB044339ORB ORE568158 <br /> #of Sections: 2 S .footage: 852 Bedrooms: 2 Bathrooms: 1 <br /> Sq. g <br /> Roofing type: Architectural Siding type: Cement Lap Heating type: Gas Cooling type: •None • <br /> Date of sale: 4/28/2025 Sale price: $138,805.00 Includes land: 0 Yes 0 No <br /> (If applicable) <br /> SECTION 4 DEALER INFORMATION(leave blank if no dealer) <br /> Name • <br /> :J&M Homes LLC License#: MSD-155 • <br /> (first,middle,last) <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: :0eAlpA04/' Date: �� <br /> SECTION 5 Mity-q5 <br /> HOME LOCATION <br /> Current Address:33213 Highway 34 SE <br /> City:Albany County:Linn State:Or Zip:97322 <br /> Park Name: (if 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:7757 Burton Place SE <br /> City:Salem County:Marion State:Or Zip:97317 <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 />