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0073748006
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RECEIVED 3/20/2007 at 3:34 PM
RECEIVING # 927729
BOOK: 651 PAGE: 807
JEANNE WAGNER
LINCOLN COUNTY CLERK, KEMMERER, WY
MANUFACTURED HOME AFFIDAVIT OF AFFIXATION
;
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1
Record and Return [ ] by Mail [ ] by Pickup to:
WFHM FINAL DOCS X9999-01M
1000 BLUE GENTIAN ROAD
EAGAN, MN 55121
This Instrument Prepared By:
JENNIFER KYNDESEN
Preparer's Name
1919 DOUGLAS,
Preparer's Address 1
,41,'
OMAHA, NE 681010000
Preparer's Address 2
0073748006
Loan Number
000807
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.
Initial: Cß
Page 1 of 5
NMFl # 7111 (MAHA) Rev 02/06
09Z77Z9
000808
CLINTON R BAIRD
[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:
USED
2001 ATLANTIC HOMES
352
076 x 031
Length x Width
New/Used Year Manufacturer's Name
Model Name or Model No.
4701-352-03573A
4701-352-03573B
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":
126 BEDFORD-TURNERVILLE RD, BEDFORD, LINCOLN, WY 83112
Street or Route, City, County, State Zip Code
5. The legal description of the Property Address ("Land") is:
SEE ATTACHED LEGAL DESCRIPTION
THIS IS A PURCHASE MONEY SECURITY INSTRUMENT.
TAX STATEMENTS SHOULD BE SENT TO: WELLS FARGO HOME MORTGAGE, P.O. BOX 11701,
NEWARK, NJ 071014701
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 [ ] 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.
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 2 of 5 Initial: C)B
NMFL # 7111 (MAHA Rev 02/06
0927729
000809
8. The Home shall be assessed and taxed as an 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:
[Closing and Agent: please refer to the Manufactured Home and Land Supplemental Closing
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.
[_] The manufacturer's certificate of origin and/or certificate of title to the Home [ ] 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 becoma fixturas on tha Land described herein
and is to be filed for record in the records where conveyances of real estate are racorded.
Page 3 of 5 Initial: (! ß
NMFL # 7111 (MAHA) Rev 02/06
0927729
000810
IN WITNESS WHEREOF, Homeowner(s} has executed this Affidavit in my presence and in the
presence of the undersigned witnesses on this day of
.
C~-eß~(J
Homeowner #1 (SEAL)
CLINTON R BAIRD
Witness
Homeowner #2 (SEAL)
Witness
Homeowner #3 (SEAL)
Witness
Homeowner #4 (SEAL)
Witness
STATE OF ~~
COUNTY OF ~ _ _
On the --1 ~ ~ day of
}
} ss.:
}
1'« tv'c fill
in the year ;;?001
otary Public in and for said State, personally appeared
personal y known to me or proved to me on the basis of satisfactory evidence to be the individual(s}
whose name(s} ¡stare} subscribed to the within instrument and acknowledged to me that
he/she/they executed the same in his/her/their capacity(ies}, and that by his/her/their signature(s} on
the instru ent, the individual(s}, or the person on behalf of which the individualls} acted, executed
the inst m nt.
Notary Signature . p
Notary Public; State Of~~
My commission expires: Ç)Q ~:¡,..
Qualified in the County of
Official Seal:
DONNA BOOTH· NOTARY PUBLIC
COUNTY OF STATE OF
LINCOLN WYOMING
MY COMMISSION EXPIRES SEPT. 20, 2007
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 02/06
0927729
Exhibit A
File 6010715020 Description
000811
The land referred to in tIus document is situated in the State of Wyoming, County of Lincoln, and is
described as follows:
A portion ofthe NE~NE~ of Section 32, Township 34 North Range 118 West ofthe 6th P.M.,
Lincoln County, Wyoming being more particularly described as follows:
Beginning at a point in the East line of said Section 32, said point being 661.86 feet South from the
Northeast corner of said Section 32;
thence South, along said East line, 246.14 feet;
thence West 353.31 feet;
thence North 247.02 feet to a point in the South line ofthe NY2NY2NE~;
thence South 89°51 '24" East, along last said South line, 353.31 feet to the point of beginning.