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5DI3 Yeerve- gderuct) S <br /> • <br /> SECTION 7 ;NATURE OF FILING.(checkallthat;a`pply) <br /> kwihuaL�S Add g e r 4c -olvner o ) <br /> EL/kAl/hame.sale. di e erty 15,1AgolivApihtst.gcBje <br /> EYFatabtykintereOlange o ' s tus ■❑ Trip Permit <br /> Egf.cgrafkiLWitiketlatice //atl d 1.6 note): <br /> SECTION 2 APPLICANT INFORMATION (pleaseprint) <br /> El Dealer/Seller 0 Lender 0 Escrow/Title Agent ❑Owner/Buyer ❑Legal Representative <br /> Name: <br /> (Trst,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: Q New Home ❑Out of state home 0 Leaving County Deed Records <br /> Manufacturer:CMH MFG, West Albany (p 1 5 7'7' <br /> Model:DRM683F Year:2026 <br /> Serial Number(s) HUD Label Number(s)*Required if new home <br /> ALB044881 ORA <br /> ALB044881 ORB <br /> ALB044881 ORC <br /> #of Sections: 3 Sq.footage: 1,836 Bedrooms: 3 Bathrooms: 2 <br /> Roofing type: Architectural Siding type: Cement Lap Heating type: Electric Cooling type: None <br /> Dateofsale: 12/4/2026 Sale price: $264,333.00 Includes land: ❑Yes ❑� No <br /> aajt:pptic blZ <br /> SECTION 4 DEALER INFORMATION(leave blank if no dealer). <br /> Name'J&M Homed 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: I t spun n A� Date: q J 13 I <br /> SECTIONS T, HOME LOCATION <br /> Current Address:2445 Pacific Blvd. SW <br /> City:Albany County:Linn State:Or Zip:97321 <br /> Park Name:(f applicable) ❑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:5073 Keene Rd. NE <br /> City:Gervais County:Marion State:Or Zip:97026 <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 />