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Record and Return to:
ACADEMY MORTGAGE CORPORATION
4055 SOUTH 700 EAST, SUITE 200
SALT LAKE CITY, UTAH 84107
Attn.: SHIPPING DEPT./DOC. CONTROL
RECEIVED 8/22/2007 at 3:02 PM
RECEIVING # 932390
BOOK: 669 PAGE: 713
JEANNE WAGNER
LINCOLN COUNTY CLERK, KEMMERER, WY
MANUFACTURED HOME
AFFIDAVIT OF AFFIXATION
000713
Before me, the undersigned Notary Public, the following personally appeared CODY SELLERS and KELLIE
SELLERS.
known to me 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 on his or her oath state as follows:
1. Homeowner owns the manufactured home ("Home") described as follows:
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MANUFACTURER'S NAME: 20TH CENTURY HOMES
MODEL: GOLDEN STATE
MODEL YEAR: 2007
MODEL NUMBER: 3003
SERIAL NUMBER: 307 KID 1830 A&B
~LENG~ AND';WIDTH: 66' 0" X 26' 8"
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2::., ·¡f.41e :a.qme wa.sblIilt in compliance with the federal Manufactured Home Construction and Safety
"Standar4S Aèt.\ j
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.
4. The Home is or will be located at the following "Property Address":
1446 BAll.,EY LOOP, LA BARGE, WYOMING 83123
(properly Addreu)
Page 1 of5
EC228A Rev. 02/02/07
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00071.4
5. The legal description of the real property where the Home is or will be pennanently affixed
("Land") is:
LOT 38 OF VIOLA SUBDIVISION PHASE NO.1, LINCOLN COUNTY, WYOMING
AS DESCRIBED ON THE OFFICIAL PLAT FILED ON JULY 3, 1983 AS
INSTRUMENT NO. 600082 OF THE RECORDS OF THE LINCOLN COUNTY
CLERK.
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 fonn, and the consent of the lessor is attached to
this Affidavit.
7, The Home is anchored to the Land by attachment to a pennanent 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 (i.g. water, gas, electricity, sewer) ("pemlanently
affixed"). TIle Homeowner intends that tlle Home be an inmlOveable fixture éU1d a pennanent
improvement to the Land.
8. TIle 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 tlle Property Address,
upon the delivery of the Home to tlle Property Address;
(a) All pemrits required by govennnental autllorities have been obtained
(b) The foundation system for the Home was designed by an engineer to meet tlle soil
conditions of the Land. All fowldations are constmcted in accordance with applicable state
and local blrilding codes, and mamúacturer's specifications in a manner sufficient to
validate any applicable manufacturer's warranty.
(c) TIle wheels, a,'l:les, towbar or hitch were removed when the Home was, or will be, placed on
tlle Property Address;
Page 2 of 5
EC228C Rev. 02/02/07
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~c;
000715
(d) TIle Home is (i) Penuanently Affixed to a foundation, (ii) has tile characteristics of site-
built housing. and (iii) is part of tile LéU1d.
(e) TIle Home is pennanently cOlU1ected to a septic tank or sewage system and other utilities
such as electricity, water and natural gas.
10. If the Homeowner is the owner of the Land, any conveyance, or fmancing of the Home and the
Land shall be a single transaction under applicable state law.
11. Other than those disclosed in this Affidavit, tile Homeowner is not aware of (i) any otller claim,
lien, or encumbrance affecting the Home, (ii) any facts of infonnation known to the Homeowner
that could reasonably affect tile validity of tile title of tile Home or the existence or non-existence
of security interests in it.
12. A Homeowner shall initial only one of tile following, as it applies to title to tile Home:
[] TIle Home is not covered by a certificate of title. TIle original manufacturer's certificate of
origin, duly endorsed to tile Homeowner, is attached to this Affidavit, or previously was
recorded in tile real property records of tile jurisdiction where tile Home is to he located.
[] The Home is not covered by a certificate of title. After diligent search and inquiry, the
Homeowner is unable to produce tile original manufacturer's certificate of origin.
[] The [ ] manufacturer's certificate of origin [ ] certificate oftitIe to tIle Home [ ] shall be
[ ] has been eliminated as required by applicable law.
[] TIle Home shall be covered by a certificate of title.
13. This Affidavit is executed by tile Homeowner(s) pursuant to applicable state law.
Page 3 of 5
EC228E Rev. 02/02/07
c)
II;
00071.6
IN WITNESS WHEREOF, Homeowner(s) has executed this Mfidavit in my presence :md in the presence of
tlle undersigned witnesses on this 20th day of July, 2007.
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I>Y SE LERS
-Borrower
-Borrower
-Borrower
-Borrower
Witness
Witness
Page 4 of 5
EC228E Rev. 02/02/07
ACADEMY MORTGAGE CORPORA TlON
Office/TitIe
00071.7
STATE OF Wyoming )
) ss:
COUNTY OF Lincoln )
On tile .p(¿J6 day of ~ ,~tJð7 before me the undersigned, a Notary Public in
and for said State, personally ap . ed CODY SELLERS and KELLlE SELLERS.
Personally known to me or proved to me on the basis of satisfactory evidence to be tile individual(s) whose
name(s) is/are subscribed to the within instrument and acknowledged to me tIlat he/she/they executed the same
in hislher/their capacity(ies), and that by his/her/their signature(s) on tile instrument, the individual(s), or the
perso~ ~ua1(S) acted, exeouted tile ins1nnuent.
Notary Signature" LORIKALAN-NOTARYPUBUC
Lori Kalan
Notary Printed Name
COUNTY OF
LINCOLN
Notary Public, State of Wyomin~
Qualified in the County of Lincoln
My conunission eÀ'Pires: 02/26/2011
l
STATE OF
WYOMING
My Commission Expires Feb. 26, 2011
Page 5 of 5
EC228E Rev. 02/02/07
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