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1,0 15 -7 7 B l'A ve S E SaL 9 31 -7 <br /> SECTION 1 NATURE OF FILING(check all that apply) <br /> [ l A:ne`t #ODS caner [a to te:. ) <br /> Ehlevd slle 'Q&k u a atf 4perty &I....elav rte orage <br /> t itNintAr.egreirAge �`� o ' g in status 0 Trip Permit <br /> [ t l�-` eut I�ince ,t,bote le stele): <br /> SECTION 2 APPLICANT INFORMATION (please print) <br /> ®Dealer/Seller ❑Lender ❑Escrow/Title Agent 0 Owner/Buyer ❑Legal Representative <br /> Name:J&M Homes LLC Phone:503-908.8166 <br /> ow,middle;Iasi) <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#:IQ E, OR No Home ID: 0New Home ElOut of state home 0 Leaving County Deed Records <br /> Manufacturer:CMH MFG, West Albany WI a q1.: <br /> Model:ING362A Year:2025 .., <br /> Serial Number(s) HUD Label Number(s)*Required if new home-.- <br /> ALB044551 ORA <br /> ALB044551 ORB <br /> ;#of Sections: 2 - Sq.footage: 852 Bedrooms:- 2 - Bathrooms:- 1 <br /> Roofing type: Architectural Siding type: Lap Cement Heating type: Electric Cooling type:- None <br /> Date of sale:_ <br /> �f <br /> 7/Z/2025 Sale <br /> applicable) <br /> price: $143,938.00 Includes land: '❑Yes ❑® No <br /> `SECTION 4 - DEALER INFORMATION(leave blank ifno dealer)` ," <br /> Name: <br /> U,st,middle,last)J&M Homes LLC License#:MSD-1:55 <br /> Address: S Pope Lane <br /> - C y:Oregon City State:OR ZIP: <br /> Email:dasla@jandmhomes.com Phone:503-908-8.166.._ <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: ftY{A JpD /1 �b� — Date:!I't/� l // ll <br /> SECTION 5 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:6157 78TH Ave. 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 />