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RECEIVED 11/22/2005 at 3:56 PM
RECEIVING # 913938
BOOK: 605 PAGE: 626
JEANNE WAGNER
LINCOLN COUNTY CLERK, KEMMERER, WY
MANUFACTURED HOME AFFIDAVIT OF AFFIXATION
Record and Return [ ] by Mail [ ] by Pickup to:
WFHM FINAL DOCS X9999-01M
1000 BLUE GENTIAN ROAD
EAGAN, MN 55121
î l{ This Instrument Prepared By:
ANJA N. KALVODA
Prepare's Name
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MORTGAGE CLOSER
Prepare's Title
808 THIRD AVENUE SOUTH SUITE 206
Prepare's Address 1
FARGO ND 58103
Prepare's Address 2
0054859467
Loan Number
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ATTENTION COUNTY CLERK: This instrument covers goods that are or are to become fixtures on the land described herein
and is to be filed for record in the records where conveyances of real estate are recorded.
Page 1 of 5 Initial: --r7L-1..../
NMFl # 7111 (MAH, A) Rev 11,/Q5)
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TOMMY R WHEELER
CHRISTINA M WHEELER
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[type the name of each Homeowner signing this Affidavit]:
being duly sworn, on his or her oath state as follows:
1. Homeowner owns the manufactured home ("Home") described as follows:
NEW
2005 HIGHLAND
CLASSIC SILVER
044 x 024
-----~--~
New/Used Year Manufacturer's Name
Model Name or Model No.
Length x Width
HR-10912A
HR-10912B
----_..-.-
Serial No. Serial No. Serial No. Serial No.
2. The Home was built in compliance with the federal Manufactured Home Construction and
Safety Standards Act.
3. If the Homeowner is the first retail buyer of the Home, Homeowner is in receipt of (i) the
manufacturer's warranty for the Home, (ii) the Consumer Manual for the Home, (iii) the
Insulation Disclosure for the Home, and (iv) the formaldehyde health notice for the Home.
4. The Home is or will be located at the following "Property Address":
611 W 6TH STREET, LABARGE, LINCOLN, WY 83123
Street or Route, City, County, State Zip Code
5. The legal description of the Property Address ("Land") is:
LOTS 1 AND 2 OF BLOCK 10 OF ALLEMAN 2ND SUBDIVISION TO THE TOWN OF LABARGE,
LINCOLN COUNTY, WYOMING AS DESCRIBED ON THE OFFICIAL PLAT THEREOF.
TAX STATEMENTS SHOULD BE SENT TO: WELLS FARGO HOME MORTGAGE, P.O. BOX 10304,
DES MOINES, IA 503060304
6. The Homeowner is the owner of the Land or, if not the owner of the Land, is in possession of
the real property pursuant to a lease in recordable form, and the consent of the lessor is
attached to this Affidavit.
7. The Home [_J is [_J shall be anchored to the Land by attachment to a permanent
foundation, constructed in accordance with applicable state and local building codes and
manufacturer's specifications in a manner sufficient to validate any applicable manufacturer's
warranty, and permanently connected to appropriate residential utilities (e.g., water, gas,
electricity, sewer) ("Permanently Affixed"). The Homeowner intends that the Home be an
immoveable fixture and a permanent improvement to the Land.
A TTENT/ON COUNTY CLERK: This instrument covers goods that are or are to become fixtures on the Land described herein
and is to be filed for record in the records where conveyances of real estate are recorded.
Page 2 of 5
NMFL # 7111
Initial: 77,....--1.../
(M/\HA) Rev 11/05
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8. The Home shall be assessed and taxed as all improvement to the Land.
9. Homeowner agrees that as of today, or if the Home is not yet located at the Property
Address, upon the delivery of the Home to the Property Address:
(a) All permits required by governmental authorities have been obtained;
(b) The foundation system for the Home was designed by an engineer to meet the soil
conditions of the Land. All foundations are constructed in accordance with applicable
state and local building codes, and manufacturer's specifications in a manner sufficient
to validate any applicable manufacturer's warranty.
(c) The wheels, axles, towbar or hitch were removed when the Home was, or will be,
placed on the Property Address; and
(d) The Home is (i) Permanently Affixed to a foundation, (ii) has the characteristics of
site-built housing, and (iii) is part of the Land.
10. If the Homeowner is the owner of the Land, any conveyance or financing of the Home and
the Land shall be a single transaction under applicable state law.
11. Other than those disclosed in this Affidavit, the Homeowner is not aware of (i) any other
claim, lien or encumbrance affecting the Home, (ii) any facts or information known to the
Homeowner that could reasonably affect the validity of the title of the Home or the existence
or non-existence of security interests in it.
12. A Homeowner shall initial only one of the following, as it applies to title to the Home:
[Closinç¡ and Aç¡ent: please refer to the Manufactured Home and Land Supplemental Clos!!:!9.
Instructions for completion instructions]:
The Home is not covered by a certificate of title. The original manufacturer's
certificate of origin, duly endorsed to the Homeowner, is attached to this Affidavit, or
previously was recorded in the real property records of the jurisdiction where the
Home is to be located.
The Home is not covered by a certificate of title. After diligent search and inquiry, the
Homeowner is unable to produce the original manufacturer's certificate of origin.
[_J The manufacturer's certificate of origin and/or certificate of title to the Home [ J shall
be [ ] has been eliminated as required by applicable law.
[_] The Home shall be covered by a certificate of title.
13. This Affidavit is executed by Homeowner(s) pursuant to applicable state law.
ATTENTION COUNTY CLERK: This instrument covers goods that are or are to become fixtures on the Land described herein
and is to be filed for record in the records where conveyances of real estate are recorded,
Page 3 of 5 Initial: íJ£ l-J
NMFL # 7111 (MAHA) Rev 11/05
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IN WITNESS WHEREOF, Homeowner(s) has executed this Affidavit in my presence and in the
presence of the undersigned witnesses on this day of
~_-A/~~--
Ho~e~er 111 (SEAL) Witness
TOMMY R WHEELER
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Homeowner 112 (SEAL) Witness
CHRISTINA M WHEELER
Homeowner 113 (SEAL) Witness
Homeowner #4 (SEAL) Witness
STATE OF
Wl' V'bYh...Jt
ss.:
( V\~ )
1 ~ day of _(\\() Jt,vnhL-A-
in the year J()n s-
COUNTY OF
On the
3efore me, the undersiÇJ¡ned, a Notary Public in r;d for said State,
~ . ,Wh2 SL.tA_ {'t...hJ.. \ /v\..LS " (1 ~ VV. i)
personally nown to me or proved to me on the basis of satisfactory evidence to be the individual(s)
whose nàme(s) is(are) subscribed to the within instrument and acknowledged to me that
helshelthey executed the same in his/her/their capacity(ies}, and that by his/her/their signature(s) on
the instrument, the individual(s}, or the person on behalf of which the individual(s) acted, executed
the instrument.
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Notary Signat re
N CU'- (0\ -S-!-ú-.I:r-: (cl
Notary Printed~me
Qualified in the County of l-'t V\ CXt.l·',-
Notary Publ;c, e Of~"1
My commission expires: () - d '0/
Official Seal:
r HpJ·!CY STiJiÚ;U - H;~¡IA.I¡Y PUliUC
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ATTENTION COUNTY CLERK: This instrument covers goods that are or are to become fixtures on the Land described herein
and is to be filed for record in the records where conveyances of real estate are recorded.
Page 4 of 5
NMFL # 7111 (MAHA) Rev 11/05
lender's Statement of Intent:
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The undersigned ("Lender") intends that the Home be an immoveable fixture and a permanent
improvement to the Land.
EN MORTGAGE, LLC
Lender
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ss.:
COUNTY OF CASS
On the 18TH day of NOVElofBER in the year 2005
before me, the undersigned, a Notary Public in and for said State, personally appeared
KATHY STOPPLER V.P. LOA~ DOCI~ENTATION BW MORTG~GE LLC
personally known to me or proved to me on the basis of satisfactory evidence to be the individual(s)
whose name(s) is (are) subscribed to the within instrument and acknowledged to me that
he/she/they executed the same in hislherltheir capacity(ies). and that by hislherltheir signature(s) on
the instrument, the individual(s). or the person on behalf of which the individual(s) acted, executed
the instrumen .
ANJA N. KALVODA
Notary Printed Name
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Qualified in the County of
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My commission expires:
Official Seal:
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ANJA N KALVODA
Notary Public
5tMe of North Dakota
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Drafted By:
[ ] Check if Construction Loan
Loan Number: 0054859467
A TTENTION COUNTY CLERK: This instrument covers goods that are or are to become fixtures on the Land describeli herein
and is to be filed for record in the records where conveyances of real estate are recorded.
Page 5 of 5
NMFL /I 7111
Initial: '1Í< L.J
(MAHA) RA'v 11 /Of.¡
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