MANUFACTURED HOME
AFFIDAVIT OF SEVERANCE
STATE OF.........................)
) SS.
COUNTY OF........................)
BEFORE ME, the undersigned Notary Public, on this day personally appeared................... (type the name(s) of each person signing this Affidavit) known to me to be the person(s) whose name(s) is/are subscribed below (each an "Affiant"), and who, being by me first duly sworn, did each on his or her oath state as follows:
............................................................
(Street or Route; City; County; State; Zip Code)
Mailing address, if different:
............................................................
(Street or Route; City; County; State; Zip Code)
............................................................
(Year; Manufacturer's Name; Manufacturer's Serial No(s).)
(Street or Route; City; County; State; Zip Code)
Name of Lienholder:........................................
Address:....................................................
Name of Lienholder:........................................
Address:....................................................
Name:....................................................
Address:................................................
IN WITNESS WHEREOF, Affiant(s) has/have executed this Affidavit in my presence and in the presence of the undersigned witnesses on this ....... day of ................, ....... ...........................(SEAL) .......................... Homeowner #1 Witness ........................... Printed Name ...........................(SEAL) .......................... Homeowner #2 Witness ........................... Printed Name ...........................(SEAL) .......................... Homeowner #3 Witness ........................... Printed Name ...........................(SEAL) .......................... Homeowner #4 Witness ........................... Printed Name STATE OF .........................)) SS. COUNTY OF ........................) The foregoing instrument was acknowledged before me this (date) by (name(s) of person(s) who acknowledged). .......................... Notary Public Signature My commission expires: ................... Official Seal:
ATTENTION RECORDER: This instrument covers goods that had been fixtures on the Property described herein and is to be filed for record in the records where conveyances of real estate are recorded.
765 ILCS 170/5-50