HomeMy WebLinkAbout963752Date
Place of Recording
Record and return to:
Wells Fargo Home Mortgage
Attn: Eric Frojd
2701 Wells Fargo Way
MAC: X9998 -01L
Minneapolis, MN 55467
Instrument Prepared By:
Eric Frojd
Loan Servicing Specialist 3
2701 Wells Fargo Way
Minneapolis, MN 55467
651 605 -3763
Preparer' ignature
Homeowner /Borrower Name(s):
Jim Henderson
Borrower #1 Borrower #2
Borrower #3 Borrower #4
Page 1 of 5
RECEIVED 3/20/2012 at 3:54 PM
RECEIVING 963752
BOOK: 783 PAGE: 466
JEANNE WAGNER
LINCOLN COUNTY CLERK, KEMMERER, WY
MANUFACTURED HOME AFFIDAVIT OF AFFIXATION
20,
Legal Description:
Tax Parcel Number:
Legal Description at Page 2.
Lot
Township Range
Jolene Henderson
7 V)466
Block Plat or Section
Quarter Quarter
Section
ATTENTION COUNTY CLERK: This instrument covers good that 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.
Jim Henderson
Jolene Henderson
[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 2006 Redman x
00467
New Used Year Manufacturer's Name Model Name or Number Length Width
017 -04452 ABC
OOPH
Serial Number
Serial Number Serial Number Serial Number
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
PO BOX 439 La Barge Lincoln WY 83123
Street or Route City County State Zip Code
5. The legal description of the Property Address "Land is typed below or please see attached
legal description:
See Attached
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 n is 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 t hat the Home be an immoveable fixture
and a permanent improvement to the Land.
8. The Home shall be assessed and taxed as an improvement to the Land.
Page 2 of 5
9. Homeowner agrees that as of today, or if the Home is not yet located athe 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 stat
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, placed on the
Property Address; and
(d) The Home is (k) Permanently Affixed to a foundation, (ii) has the characteristics of sit -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 on 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 the title to the Home:
[Closing Agent: please refer to the Manufactured Home and Land Supplemental Closing Instructions
for completion instructions]
13. This Affidavit is executed by Homeowner(s) pursuant to applicable state law.
Page 3 of 5
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 M shall be
has been eliminated as required by applicable law.
The Home shall be covered by a certificate of title.
u0468
IN WITNESS WHEREOF, Homeowner(s) has executed this Affidavit in my presence and the presence of
the dersigned itnesses on this day of 20
Borrower #1
Jim Henderson
Bo rower #2
J ene Henderson
Borrower #3 Witness
Borrower #4
STATE OFL U/11 /l')
COUNTY OP. 5
the /y day ofi k tQ in the year0O /D. before me, the
undersigned, a Notary Public in and for said State!, personally appeared
Jim Henderson and Jolene Henderson
personally known t• me or proved to me on the basis of satisfactory evidence to be the individu
whose name(s) is subscribed to the within instrument and ackno dged to me that he /she /tt y
executed the same in his er capacity(ies), and that by his /her their i nature(s) on the
instrument, the individu 1(s), or the person on behalf of which the in ua' s) cted, executed the
instrument.
Page 4
ary Signa Ire
mO /7)e-19-
Notary Printed Name
Notary Public; State of
Qualified in the County o
My commission expires:
Official Seal:
Betty Moceika Notary Public
f Bounty of State of
Lincoln
Wyoming 0
My Commission Extylfes 6 /19 /2 t�e P
ss.:
/4
(SEAL)
(SEAL)
(SEAL)
(SEAL)
Witness
Witness
Witness
fieoi
00469
C
Lender's Statement of Intent:
The undersigned "Lender intends that the Home be an immoveable fixture and a permanent
improvement to the Land.
Wells Fargo Bank NA
ender
By. ngel M Morgan
Its: Angela M Morgan Vice President
Documentation, Wells Fargo Ba
STATE OF MINNESOTA
ss.:
COUNTY OF DAKOTA
On the a 1 day of c/LrrI-Li in the year OOP" before me, the
undersigned, Notary Public in a?dd for sai ate, person Ily appeared
V d l
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.
Notary Signature
Notary Public: Cheryl L. Lynn
Notary Public; State of MINNESOTA
Qualified in the County of a it:.
My commission expires: 1 is
Official Seal:
Page 5 of 5
CHERYL L. LYNN
f- NOTARY PUBLIC MINNESOTA
My Commission Expires Jan. 31, 2015
Witness
f Loan Witness
ffi
00470
EXHIBIT A
LEGAL DESCRIPTION
Lots 7 and 8 of Block 1 of Apeman 2nd Addition, Lincoln County, Wyoming as described on
the official plat No. 332B filed on November 29, 1989 as instrument No, 711017 of the records
of the Lincoln County Clerk.
00471