STATE OF SOUTH CAROLINA | ) | MANUFACTURED HOME |
) | LIEN AFFIDAVIT | |
COUNTY OF ______________ | ) |
(1) | Name of Owner: |
(2) | Description of Manufactured Home: |
Date of Manufacture: | |
Manufacturer: | |
Model year: _________________ Make: | |
Width: _________________ Length: | |
Identification Number (VIN): |
_________________________________________________________
_________________________________________________________
_________________________________________________________
Tax map number______________________
Tax billing address__________________________________________
_________________________________________________________
The owner certifies that the above information provided by the owner is true and correct to the best information and belief of the owner.
Date: ____________________ |
Signature of Owner |
Type or print name of owner |
Witness: |
Witness: |
STATE OF SOUTH CAROLINA | ) | |
COUNTY OF ________________ | ) | PROBATE |
Before me, the undersigned Notary Public, personally appeared ______________________________, who, being duly sworn, deposed and said that he saw ___________________________________, sign, seal, and deliver the foregoing Affidavit and that he, together with ____________________________ witnessed the execution thereof.
______________________________
SWORN to before me this
_________ day of _______________
Notary Public for________________(L.S.)
My Commission Expires:________
S.C. Code § 56-19-540