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55 S m C C �� iian <br /> S E, ,��►� S V 1' I l <br /> SECTION 1 NATURE OF FILING(check:all that apply) <br /> 0 Nev home to MHODS ❑ Adding or removing a co-owner ❑ Demolition(Date: ) <br /> • ❑ Used home sale ❑ Recording as real property ❑ Converted to storage <br /> -❑ Security interest change ❑ Removing from real property status. -- ❑� Trip Permit <br /> ❑ Transfer by inheritance ❑ Other(please note): <br /> SECTION 2APPLICANT. APPLICAN ,MATION (please.prmt) '` <br /> ■❑Dealer/Seller ❑.Lender ❑Escrow/Title Agent ❑Owner/Buyer ❑Legal Representative - <br /> Name: <br /> rsr,middle,last)J&M Homes LLC Phone:541-928=1471:. <br /> Address:3321.3'Hwy 34 SE <br /> City:Albany_. State:OR. .- ' ..._ ZIP:97322 .. .. .. . <br /> Email:.lsimon@jandmhomes.com - <br /> SECTION 3 HOME.INFORMATION (information m bold is required) <br /> Home ID#: OR No Home ID: ❑1 New Home ❑Out of state home ❑Leaving County Deed Records <br /> • Manufacturer:C M H (al Q 9 E& <br /> Model:72DRM28483CH25 Year 2025 <br /> Serial Number(s) HUD Label Number(s)*Required if new home.' <br /> ALB0442360RA 0RE567385 . <br /> - ALB0442360RB - ORE567386 ' ' <br /> ..__*of Sections:: 2 Sq.footage: 1296 Bedrooms: 2 Bathrooms::2 <br /> ---Roofing type; Architectural Siding type: Vertical Wood Heating type Electric.:, Cooling type: None <br /> Date•ofsale: <br /> (I.fapplicable) <br /> 6/4/25 Sale price: 130129 Includes land: ❑ Yes No <br /> ::SECTION 4 ; DEALER INFORMATION(leave blank if no dealer) <br /> Name:_ _.. <br /> (first,middle,last) • <br /> J&M Homes LLC License#:MSD155 <br /> Address:15850 S Pope Lane <br /> - • City:-Oregon_City . . State:OR 4tY:97045 <br /> Briiai 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: ic) � J a✓vy Date: /0/52/25 <br /> SECTION.5. , <br /> HOME LOCATION -.;: <br /> Current.Address:33213 Hwy 34 SE <br /> City:Albany County:Linn State:OR Zip:97322 <br /> Park Name: (f applicable) (]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:11555 McClellan Ln SE <br /> City:Aumsville County:Marion State:OR Zip:97325 <br /> Park Name: (f applicable) ❑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:lsimon@jandmhomes.com <br /> Page 2 <br />