HomeMy WebLinkAbout968842(To be recorded with Security Instrument)
AFFIXATION AFFIDAVIT REGARDING
MANUFACTURED (AND FACTORY BUILT) HOME
The State of WYOMING)
County of LINCOLN)
Before me, the undersigned authority, on this day personally appeared JEFFREY A
KALLSTROM, A MARRIED MAN AS HIS SOLE AND SEPARATE PROPERTY known to
me to be the person(s) whose name(s) is /are subscribed below, and who, being by me first duly
sworn, did each on his /or her oath state as follows:
Description of Manufactured Home
Used
New /Used Year Manufacturer's Name Model Name and Model No.
64 X 26.8
Length X Width
Manufactured Home Location
391 VALLEY VIEW DRIVE LINCOLN
Street County
COKEVILLE
City
GUERDON
1997 INC.
HOMES,
GDBOID509610000A
B UNKNOWN
Serial Number HUD
WYOMING 83114
State Zip Code
Affixation Affidavit Regarding Manufactured Home
43.28 Page 1 of 4
RECEIVED 1/3/2013 at 4:17 PM
RECEIVING 968842
BOOK: 802 PAGE: 82
JEANNE WAGNER
LINCOLN COUNTY CLERK, KEMMERER, WY
KALLSTROM
Loan 110225
UNKNOWN UNKNOWN
.J)W
0008
00®31
110225
In addition to the covenants and agreements made in the Security Instrument, Borrower covenants
and agrees as follows:
1. The manufactured home described above located at the address above is permanently affixed
to a foundation and will assume the characteristic of site -built housing.
2. The wheels, axles, tow bar, or hitch were removed when said manufactured home was placed
on the permanent site.
3. All foundations, both perimeter and piers for said manufactured home have footings that are
located below the frost line or in compliance with local building codes or requirements.
4. If piers are used for said manufactured home, they will be placed where said home
manufacturer recommends.
5. If state law so requires, anchors for said manufactured home have been provided.
6. The manufactured home is permanently connected to a septic or sewage system and other
utilities such as electricity, water and natural gas.
7. No other lien or financing affects said manufactured home or real estate, other than those
disclosed in writing to Lender.
8. The foundation system of the manufactured home has been designed by an engineer, if
required by state or local building codes, to meet the soil conditions of the site.
9. Borrower(s) acknowledges his or her intent that said manufactured home will become
immovable property and part of the real property securing the security instrument.
10. The manufactured home will be assessed and taxed as an improvement the real property.
I /We understand that if Lender does not escrow for these taxes, that I /We will be responsible
for payment of such taxes.
11. If the land is being purchased, such purchase and said manufactured home represent a single
real estate transaction under applicable state law.
12. Said manufactured home has been built under the Federal Manufactured Home Construction
and Safety Standards that were established June 15, 1976.
13. This Affidavit is executed by Borrower(s) pursuant to applicable state law.
14. All permits required by governmental authorities have been obtained. Borrower(s) certifies
that Borrower(s) is in receipt of manufacturer's recommended maintenance program
regarding the carpets and manufactures warranties covering the heating /cooling system, hot
water heater, range, etc... and the formaldehyde health notice.
Affixation Affidavit Regarding Manufactured Home
3' 43.28 Page 2 of 4
KAWZ-
In Witness Whereof, Borrower(s) has executed this Affidavit in my presence and in the presence of
undersigned witnesses on this 27TH day of DECEMBER, 2012.
o0
BORROWER JEFFREY A KALLSTROM DATE
Witness
STATE OF cLLk
COUNTY OF 'B- e aJ L4 I C E
The foregoing instrument
kivw<t4er a�12
Witness
was acknowledged before me this day of
by
who is personally known to me (ye o) or who provided
as identification.
Affixation Affidavit Regarding Manufactured Home
43.28 Page 3 of 4
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4v n c, G0 ra a AC A U 4 kale s �ry nrti
i2-`21/12
N. ary Public
Print Name: Load u =tveck
My Commission Expires: 0/.24 C
1111111111111411111 i 11111111111111 i 11111:11111 i 111111 �1III
LORI TIHORNOCK
NOTARY PUBLIC
STATE OF IDAHO
1111111 III 11111311111111111111111111111111111111
110225
Kee
Lender's Statement of Intent:
The undersigned "Lender intends that the Home be an immovable fixture and a permanent
improvement to the Land.
Lender: ADVANTAGE PLUS FEDERAL CREDIT UNION
By:
.4A
Authorized Signature
STATE OF d�►7 CI
COUNTY OF Pear Let i e
The foregoing instrument was acknowledged
by JOb1t i eVTh 1 1'-
an agent of ADVANTAGE PLUS FEDERAL
to me or who provided
nnunnuuGwiiuununnuniunuuumm11un
LORI THORNOCK
NOTARY PUBLIC
STATE OF IDAHO
nnnnunuuUnaiUUUUnuaunununnni��n
Affixation Affidavit Regarding Manufactured Home
43.28 Page 4 of 4
110225
before me this del day of Dec:eaibkr
CREDIT UNION, Lender, who is sersonally known
as iden cation.
Notary Public L
Print Name: Jog dto/a -2-/
My Commission Expires: /04 /'7
2,esi4 at rY{o,.
Attention County Clerk: This instrument covers goods that are or are to become fixtures on the
Property described herein and is to be filed for record in the records where Security Instruments on
real estate are recorded. Additionally, this instrument should be appropriately indexed, not only as
Security Instrument but also as a financing statement covering goods that are or are to become
fixtures on the Property described herein.
JAk
00035
'MP&
Exhibit "A"
ALL OF LOTS 18, 19 AND 20 OF THE TAYLOR SECOND SUBDIVISION, LOCATED IN
LINCOLN COUNTY, WYOMING, FILED SEPTEMBER 6, 1978 AS INSTRUMENT NO.
513535 IN THE OFFICE OF THE LINCOLN COUNTY CLERK.
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