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r� SLtflSflIneC 3� i V rU �v Irl'\ 3JQ 5 a b <br /> f° ,. ,µ # u =d ' 'K Y. � 'IIS ' �k �I th f ` ! : . <br /> .. �a� ': .� �I�� �.�a �. �����s <br /> • 'ha t,• ecu nt . 110, C g . neys1 to ' i. ! e o - iol( '' . <br /> • dil : • re. ► os• 11 ' - n% 'ii r. a •.er . - O Trip permit tAcyEltykniszage <br /> V. 0 er: <br /> t .r k .� a`� 4Oaxa al tg maw"'" &Var <br /> Dealer/seller ❑ Lender I ❑ Escrow/title agent ❑ Owner/buyer ❑ Legal representative <br /> Name:J &M Homes, LLC <br /> Address(including city,state,and ZIP):12901 SE 97th Ave #100, Clackamas, OR 97015 <br /> Phone:503-908-8166 <br /> Email:bbaxter@jandmhomes.com <br /> ifIO E IVFd MAT.Q V,(' requipea .yq• . vio t <br /> Home ID number(if known): DMV X-plate number(if known): <br /> 1�7 G <br /> Moving in from another state <br /> Has no home ID or X-plate because: ❑ Coming out of county deed records <br /> ❑ Other: <br /> Manufacturer:CMH Manufacturing, Hermiston Model:2017 Columbia River Year:2020 <br /> Manufacturer serial number HUD number <br /> HER031 9600RA <br /> HER0319600RB <br /> *Number of sections:2 *Square footage: 1,512 *Number of bedrooms:2 *Number of bathrooms:2 <br /> *"Type of roofing:Composition *'Type of siding:Wood *Heating:Electric *Cooling:None <br /> *Date of sale: *Sales price: *Includes land: ❑ Yes O No <br /> s <br /> ' * AT o 44Ie `..; Fes.. <br /> Dealer name: Dealer license number: Dealer address and phone: <br /> J & M Homes, LLC MSD-155 12901 SE 97th Ave #100 <br /> Clackamas, OR 97015 <br /> 503-908-8166 <br /> OThis 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. <br /> I hereby declare that the above statement is true to the best of my knowledge and belief,and that I understand it is <br /> made for use as evidence in court and is subject to penalty for perjury. <br /> Dealer name (print): De ler signature:, <br /> -�, Date' <br /> J & M Homes, LLC )(4 ` te3 )j <br /> " <br /> f.� 11 <br /> t .a'Z R. ® 11 ( ® Ci bI O e 73, , <br /> Transporter name: Transporter address and phone: <br /> J& M Homes, LLC 12901 SE 97TH Ave#100 Clackamas, OR 97015 <br /> 440-2952(7117/CoNI) Page 2 <br />