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.--) <br /> • I Sci/Lirn 9.73 h <br /> -SECTION 1 NATURE OF FILING (checkallthat_apply) . ' <br /> 1/ eti+s 3 t ODS ft4.11KgNatQavin a c -o er ate: ) <br /> ale Re r on rted o storage <br /> c •y•• e hange 111--/kenatrag,fascriptpatus El Trip Permit <br /> eill5Atedtance e t <br /> SECTION 2. APPLICANT INFORMATION.(please'print) <br /> ❑■ Dealer/Seller ❑Lender ❑Escrow/Title Agent 0 Owner/Buyer ❑Legal Representative <br /> Name:(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@jandmhomes.com <br /> SECTION 3 HOME;INFORMATION (information in bold is;requred) <br /> Home ID#: OR No Home ID: 0 New Home ❑Out of state home ❑Leaving County Deed Records <br /> Manufacturer:CMH (0I 3 9 5 C, <br /> Model:72DRM24382BH26 Year:2026 <br /> Serial Number(s) HUD Label Number(s)*Required if new home <br /> ALB045147ORA ORE571701 <br /> ALB045147ORB ORE571702 <br /> #of Sections: 2 Sq.footage: 948 Bedrooms: 1 Bathrooms: 2 <br /> Roofmg type: Architectural Siding type: Vertical Wood Heating type: Electric Cooling type: None <br /> Date of sale: 12/10/25 Sale price: 134888 Includes land: ❑Yes ❑■ No <br /> (If applicable) <br /> SECTION 4 DEALER INFORMATION (leave blank if„no dealer) . <br /> Name` <br /> first,middle,las1J 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 underst d it can b used as evidence in court and is subject to a penalty of perjury. <br /> Signature: � �C -) Date:r Q/r/ <br /> SECTION 5 : ':. : <br /> HOME LOCATION <br /> Current Address:33213 Hwy 34 SE <br /> City:Albany County:Linn State:OR Zip:97321 <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:219 Cascade Hwy NE <br /> City:Salem County:Marion State:OR Zip:97317 <br /> Park Name: (if applicable) 0 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 />