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0108594284
Alliance Title Escrom,
P.O. Box 1367
Kemmerer WV 83101
Record and Return by Mail by Pickup to:
WFHM FINAL DOCS X2599 -024
405 SW 5TH STREET
DES MOINES, IA 50309 -4600
This Instrument Prepared By:
CLOSER I OMAHA
Preparer's Name
1919 DOUGLAS,
Preparer's Address 1
OMAHA, NE 681010000
Preparer's Address 2
0108594284
Loan Number
Page 1 of 5 Initial: L. 6.
NMFL 7111 (MAHA) Rev 2/4/2008
RECEIVED 12/1/2009 at 3:22 PM
RECEIVING 950830
BOOK: 737 PAGE: 259
JEANNE WAGNER
LINCOLN COUNTY CLERK, KEMMERER, WY
600259
MANUFACTURED HOME AFFIDAVIT OF AFFIXATION
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.
DARIN G POCOCK
[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 2002 MARLETTE CASA DEL RIO 9509
New /Used Year Manufacturer's Name
H021572A H021572B
Street or Route, City, County, State Zip Code
Page 2 of 5 Initial: /J.
NMFL 7111 (MAHA) Rev 2/4/2008
050 x 026
Model Name or Model No. Length x Width
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
50 ASPEN WAY, STAR VALLEY RANCH, LINCOLN, WY 83127
5. The legal description of the Property Address "Land is:
LOT 101 OF STAR VALLEY RANCH PLAT 3, LINCOLN COUNTY, WYOMING AS DESCRIBED ON
THE OFFICIAL PLAT FILED ON MARCH 3, 1971 AS INSTRUMENT NO. 428885 OF THE
RECORDS OF THE LINCOLN COUNTY CLERK.
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 1 is 1 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.
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:
[Closingand Agent: please refer to the Manufactured Home and Land SupplementalClosing
Instructionsfor completioninstruction4:
U 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.
U 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.
[Xi The manufacturer's certificate of origin and /or certificate of title to the Home shall
be (,Q has been eliminated as required by applicable law.
U 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: jO,
NMFL 7111 (MAHA) Rev 2/4/2008
,`pOu261
IN WITNESS WHEREOF, Homeowner(s) has executed t1 Affidavit in my presence and in the
presencp of the undersigned witnesses on this 30 Gh day of
Homeowner #1 (SEAL)
DARIN G POCOCK
Witness
Homeowner #2 (SEAL) Witness
Homeowner #3 (SEAL) Witness
Homeowner #4 (SEAL) Witness
STATE OF GVC/Y) l�ir)9C
s s
COUNTY OF
On the SO day of /Y G in the year 000 9'
before me, the undersigned, a Notary Public in and for said State, personally appeared
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 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.
Page 4 of 5
NMFL 7111 (MAHA) Rev 2/4/2008
Notary Signature Notary Printed Name
Notary Public, State of Gf/r 0).- /'I.r/Y
My Commission expires: 9 /5
Official Seal:
O X262
G40/9/19 Ai /9 YE/2 S
Qualified in the County of
GLORIA K. BYERS
County of
Lincoln
NOTARY PUBLIC
State of
Wyoming
My Commission Expires September 15, 2011
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.