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Home My WebLink About971099181838 1 L_ f y Record and Return Mail J by Pickup�to: FINAL DOCS T7 -01F C 4101 WISE BLVD BLDG 108 SAN ANTO O, TX 78251 -4200 This Instrument Prepared By: TAMARA FLOYD Preparer's Name 1616 W 17TH ST, FLOOR 1 Preparer's Address 1 TEMPE, AZ 852816217 Preparer's Address 2 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 1 Initial. U b NMFL 7111 (MAHA) Rev 2/4/2008 MANUFACTURED HOME AFFIDAVIT OF AFFIXATION Chicago Title Servicelink Division 4 000 industrial Blvd Aliquippa, PA 15001 11 1 II 0 0 I_ 5 RECEIVED 5/20/2013 at 4:48 PM RECEIVING 971099 BOOK: 812 PAGE: 115 JEANNE WAGNER LINCOLN COUNTY CLERK, KEMMERER, WY 1 CHARLES M THORNTON [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 1996 MODULINE INDUSTRIES New /Used Year Manufacturer's Name 15888 15888 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 1133 W 8TH ST, LA BARGE, LINCOLN, WY 83123 Street or Route, City, County, State Zip Code 5. The legal description of the Property Address "Land is: LEGAL DESCRIPTION ATTACHED HERETO AND MADE A PART THEREOF TAX STATEMENTS SHOULD BE SENT TO: WELLS FARGO HOME MORTGAGE, P.O. BOX 11758, NEWARK, NJ 071014758 ARDMORE 28812 066 x028 Model Name or Model No. Length x Width 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 [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. Page 2 Initia NMFL 7111 (MAHA) Rev 2/4/2008 00 1g 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: 11. (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 (1) 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. 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]: 1 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. [1 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. f The manufacturer's certificate of origin and /or certificate of title to the Home 1 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 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 Initial: NMFL 7111 (MAHA) Rev 2/4/2008 01.17 IN WITNESS WHEREOF, Homeowner(s) has executed this Affidavit in my presence and in the presenc o the `pdersigned itnes s o n this f 3 day of Homeowner #1 (SEAL) Witness CHARLES M THORNTON Homeowner #2 (SEAL) Homeowner #3 (SEAL) Witness Homeowner #4 (SEAL) Witness STATE OF LUj 7)( 7 COUNTY OF 2.7i On the day of in the year 4e before me, t signed, a Notary Public it and for said State, personally appeared 22 7 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 Official Seal: Page 4 NMFL 7111 (MAHA) Rev 2/4/2008 ss.: Notary Public, State of yG- at My Commission expires: H/49/ Witness Notary Printed Name Qualified in the County of ge/ xee; 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. Q 0 i S Exhibit "A" Legal Description Lots12 13 of Block 3 of West Valley Subdivision, Lincoln County, Wyoming, as described on the official plat filed on June 30, 1981 as Iustrtttnent No. 560645 of the records of the Lincoln County Clerk. Tax ID 26120720502500