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996. E <br /> a Oc) (Lyn <br /> SECTION 1 . NATURE OF FILING(check all that apply) - <br /> ENwirrteraurit4HTS 11%r\A'atingNorNapINg'alceptinvner 'EL-13te rfiatitc/Pitt e: <br /> lErggtidlbure-sale N/Re6-Rling/A-ralneerty [N--Carcrateditrsturage <br /> D,"Sertuitfintie-?esi\eigute p tatus Ej Trip Permit <br /> )2tArtikerVa. •Itherance KA5ther,preasnot07- <br /> SECTION 2 APPLICANT INFORMATION(pleaseprint) <br /> 0 Dealer/Seller 0 Lender El Escrow/Title Agent 0 Owner/Buyer 11]Legal Representative <br /> Name: <br /> (first,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@jandrnhornes.corn <br /> Home ID#: OR No Home ID: ID New Home Li Out of state home 1:1 Leaving County Deed Records <br /> Manufacturer:CMH <br /> Model:72TP016602AH26 Year:2026 <br /> Serial Number(s) HUD Label Number(s)*Required if new home <br /> ALB045085OR <br /> #of Sections: 1 Sq.footage: 900 Bedrooms: 2 Bathrooms: <br /> Roofing type: Architectural Siding type: Vertical Wood Heating type: Electric Cooling type: None <br /> Date of sale: 1/30/26 Sale price: 91888 Includes land: [ ]Yes C]No <br /> gfapplicablej <br /> SECTION 4 DEALER INFORMATION(leave blank if nodeaFer F <br /> Name. • <br /> (first,middle, .last)J&M Homes LLC 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 understand it can be used as evidence in court and is subject to a penalty of perjury. <br /> Signature: grt,k.: Date: <br /> SECTk0157F LOCATION <br /> Current Address:33213 Hwy 34 SE <br /> City:Albany County:Linn State:OR Zip:97322 <br /> Park Name: (j applicable) 111 This is a dealer lot or storage facility <br /> J This home is being moved to a new location Complete the section below <br /> New Address:16688 Highway 99E NE#7 <br /> City:Woodburn County:Marion State:OR Zip:97071 <br /> Park Name:(if applicable) Cha-kcao Vi:)!?(,e El 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 /> Page 2 <br />