When an application for retirement is filed with the Department of Revenue within sixty (60) days of recording the related affidavit of affixation in the official records of the chancery clerk in the county, or in the judicial district in counties having more than one (1) such district, in which the real property is located and the application is thereafter accepted by the department, the requirements of this section shall be deemed satisfied as of the date the affidavit of affixation is recorded.
THIS INSTRUMENT PREPARED BY: INDEXING INSTRUCTIONS:
____________________________ ______________________
____________________________ ______________________
AFFIDAVIT OF AFFIXATION
(MANUFACTURED HOME OR MOBILE HOME)
STATE OF _________________
COUNTY OF ________________
Before me, the undersigned notary public in and for said county and state, appeared [type the name and address of each homeowner signing this affidavit], known to me (or satisfactorily proven) to be the person(s) whose name(s) is/are subscribed below (each a "homeowner"), and who, being by me first duly sworn, did each by personal oath state as follows:
________________________________________________________________
Manufacturer's Name Make Model Name Model Year
________________________________________________________________
Manufacturer's Serial No./VIN Length/Width New/Used
________________________________________________________________
Street City County State Zip Code
[insert legal description]
[ ] The home is currently covered by a certificate of title and the homeowner shall surrender the original title to a designated agent on behalf of the Department of Revenue;
[ ] The home is currently covered by a manufacturer's certificate of origin and the homeowner shall submit the original certificate of origin to a designated agent on behalf of the Department of Revenue; or
[ ] The home is not covered by a certificate of title and the owner of the manufactured home, after diligent search and inquiry, is unable to produce the original manufacturer's certificate of origin for the home, and an affidavit of ownership is attached hereto.
[ ] Is not subject to any security interest or lien; or
[ ] Is subject to the following security interests or liens:
________________________________________________________________
Lienholder #1 Original Principal Amount Secured
________________________________________________________________
Address:
________________________________________________________________
Lienholder #2 Original Principal Amount Secured
________________________________________________________________
Address:
________________________________________________________________
Name of Authorized Representative_________________________________
Mailing Address _________________________Phone Number __________
Further, affiant(s) sayeth naught.
________________________________________________________________
Signature of Homeowner #1:
________________________________________________________________
Printed Name Address City State Zip Code
________________________________________________________________
Signature of Homeowner #2 (If more than one (1) homeowner):
________________________________________________________________
Printed Name Address City State Zip Code
Sworn to and subscribed before me this the _____ day of ____________, 20__.
_______________________________
Notary Public
My Commission Expires: _________________________
THIS INSTRUMENT PREPARED BY: INDEXING INSTRUCTIONS:
____________________________ ______________________
____________________________ ______________________
AFFIDAVIT OF SEVERANCE
(MANUFACTURED HOME OR MOBILE HOME)
STATE OF ___________________
COUNTY OF __________________
Before me, the undersigned notary public in and for said county and state, appeared [type the name and address of each homeowner signing this affidavit], known to me (or satisfactorily proven) to be the person(s) whose name(s) is/are subscribed below (each a "homeowner"), and who, being by me first duly sworn, did each by personal oath state as follows:
__________________________________________________________________
Manufacturer's Name Make Model Name Model Year
________________________________________________________________
Manufacturer's Serial No./VIN Length/Width New/Used
[ ] Is not subject to any security interest or lien; or
[ ] Is subject to the following security interests or lien:
________________________________________________________________
Lienholder #1 Original Principal Amount Secured
________________________________________________________________
Address:
________________________________________________________________
Lienholder #2 Original Principal Amount Secured
________________________________________________________________
Address:
[ ] A release of the real property security interest or lien from each of the lienholders identified in paragraph 6 of this affidavit, if any, is attached hereto; or
[ ] A statement from each of the lienholders identified in paragraph 6 of this affidavit is attached hereto authorizing the lienholder's security interest or lien to be recorded on the face of the certificate of title and, if more than one (1) lienholder, the order of priority of the same.
________________________________________________________________
Name of Authorized Representative Mailing Address Phone Number
This affidavit is executed by homeowner(s) pursuant to applicable state law and shall be recorded in the official land records in the county in which the home is located.
Further, affiant(s) sayeth naught.
_______________________________________
Signature of Homeowner #1:
________________________________________________________________
Printed Name Address City State Zip Code
________________________________________________________________
Signature of Homeowner #2 (If more than one (1) homeowner):
________________________________________________________________
Printed Name Address City State Zip Code
Sworn to and subscribed before me this the _____ day of ____________, 20__.
_______________________________
Notary Public
My Commission Expires: _________________________
THIS INSTRUMENT PREPARED BY: INDEXING INSTRUCTIONS:
____________________________ ______________________
____________________________ ______________________
AFFIDAVIT OF DESTRUCTION
(MANUFACTURED HOME OR MOBILE HOME)
STATE OF ___________________
COUNTY OF __________________
Before me, the undersigned notary public in and for said county and state, appeared [type the name(s) of each homeowner signing this affidavit], known to me (or satisfactorily proven) to be the person(s) whose name(s) is/are subscribed below (each a "homeowner"), and who, being by me first duly sworn, did each by personal oath state as follows:
________________________________________________________________
Manufacturer's Name Make Model Name Model Year
________________________________________________________________
Manufacturer's Serial No./VIN Length/Width New/Used
This affidavit is executed by homeowner(s) pursuant to applicable state law and shall be recorded in the official land records in the county, or in the judicial district in counties having more than one (1) such district, in which the home is located.
Further, affiant(s) sayeth naught.
_______________________________________
Signature of Homeowner #1
________________________________________________________________
Printed Name Address City State Zip Code
________________________________________________________________
Signature of Homeowner #2 (If more than one (1) homeowner)
________________________________________________________________
Printed Name Address City State Zip Code
Sworn to and subscribed before me this _____ day of _______________, 20__.
_______________________________
Notary Public
My Commission Expires: _________________________
THIS INSTRUMENT PREPARED BY: INDEXING INSTRUCTIONS:
____________________________ ______________________
____________________________ ______________________
AFFIDAVIT OF OWNERSHIP
(For Mobile Homes Manufactured before July 1, 1999)
STATE OF _________________________
COUNTY OF ________________________
BEFORE ME, the undersigned notary public in and for said county and stated, appeared [Name of Grantor(s)] who are known to me or have produced satisfactory evidence of their identity to be the person(s) whose name(s) is/are subscribed below, and how being first duly sworn, did each on personal oath state the following to wit:
__________________________________________________________________
Name Street Address
__________________________________________________________________
City, State, Zip Code Telephone Number
__________________________________________________________________
Name Street Address
__________________________________________________________________
City, State, Zip Code Telephone Number
[Attach Any Additional Owners as Exhibit A]
__________________________________________________________________
Manufacturer's Name Make Model
__________________________________________________________________
Manufacturer's Serial No./VIN Length & Width Model Year
__________________________________________________________________
Street Address City State
__________________________________________________________________
Zip Code County County Tax Parcel Number
[insert legal description]
[ ] Is not subject to any security interest or lien; or
[ ] Is subject to the following security interests or liens:
__________________________________________________________________
Lienholder #1 Original Principal Amount Secured
__________________________________________________________________
Address
__________________________________________________________________
Lienholder #2 Original Principal Amount Secured
__________________________________________________________________
Address
[ ] Is assessed as real property and a Certificate of Mobile Home is filed in the office of the chancery clerk it is recorded in Land Deed Book __________, Page _____________; or
[ ] Is assessed as personal property. The mobile home account number is_________________________.
Further, affiant(s) sayeth naught.
WITNESS MY SIGNATURE, on this [day] day of [Month], [Year].
__________________________
[Grantor Name(s)]
__________________________
[Grantee Name(s)]
STATE OF ____________________
COUNTY OF ____________________
Personally appeared before me, the undersigned authority in and for the said county and state, on this [Day] day of [Month], [Year], within my jurisdiction, the within named [Grantor Name] who acknowledged that (he) (she) (they) executed the above and foregoing instrument.
So subscribed and sworn before me this the [Day] day of [Month], [Year].
_________________________________
Notary Public
My Commission Expires: _________
Miss. Code § 63-21-30