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;.- a 9ui R v er Rot NE S. 9 7 ) 3 -7 <br /> SECTION.1 NATURE OF FILING(check all that apply)` • <br /> INVAA-Itasa PlITODS dl rrftita wner V, �i tt te: <br /> ssItl i e --eo vagtet 9toltge <br /> e i rasdasge lalpfo tert3L,stAtus ❑■ Trip Permit <br /> $'iasfe sink t tce er a te): <br /> SECTION 2.: _ APPLICANT:INFORMATION (please print) <br /> E]Dealer/Seller ❑Lender ❑Escrow/Title Agent ❑Owner/Buyer 0 Legal Representative <br /> Name:(fast,middle,last)J&M Homes LLC Phone:541-928-1471 <br /> Address:33213 Hwy 34 SE <br /> City:Albany State:OR ZIP:97322 <br /> Email:Isimon@jandmhomes.com <br /> SECTION 3 HOME INFORMATION(information is`required) <br /> Home ID#: r OR No Home ID: ■ New Home <br /> N U� ❑ ❑Out of state home ❑Leaving County Deed Records <br /> Manufacturer:CMH / „ 1 . 1 -� <br /> Model:72TP028724AH26 Year:2026 4 <br /> Serial Number(s) HUD Label Number(s) *Required if new home <br /> ALB045153ORA ORE571714 <br /> ALB045153ORB ORE571715 <br /> ti of Sections: 2. Sq.footage: 1920 Bedrooms: 4 Bathrooms: 2 <br /> Roofmg type: Architectural Siding type: Vertical Wood Heating type: Electric Cooling type: None <br /> Date of sale: 3/9/26 Sale rice: <br /> ffapplicable) P 161072 Includes land: 0 Yes ❑■ No <br /> . SECTION 4 DEALER INFORMATION.(leave blankif no dealer) <br /> Name.J&M Homes LLC <br /> Urst,middle,rant) 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 unders nd it can be used as evidence in court and is subject to a penalty of perjury. <br /> Signature: Date: '5/26A • <br /> SECTION 5 HOME LOCATION - <br /> Current Address:33213 Hwy 34 SE <br /> City:Albany County:Linn , State:OR Zip:97322 <br /> Park Name:(if applicable) ■❑This is a dealer lot or storage facility <br /> iJ This home is being moved to a new location Complete the section below <br /> New Address:22901 River Rd NE <br /> City:St Paul County:Marion State:OR Zip:97137 <br /> Park Name: (if 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:Isimon©jandmhomes.com <br /> Paget <br />