HomeMy WebLinkAbout972096Record and Return by Mail by Pickup to:
FINAL DOCS T7408 -01F
4101 WISEMAN BLVD BLDG 108
SAN ANTONIO, TX 78251 -4200
This Instrument Prepared By:
LISA HOUSE
Preparer's Name
9780 S MERIDIAN BLVD, 2ND FL
Preparer's Address 1
ENGLEWOOD, CO 801125910
Preparer's Address 2
MANUFACTURED HOME AFFIDAVIT OF AFFIXATION
RECEIVED 7/19/2013 at 10:53 AM
RECEIVING 972096
BOOK: 816 PAGE: 69
JEANNE WAGNER
LINCOLN COUNTY CLERK, KEMMERER, WY
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: p.c. 5'
NMFL 7111 (MAHA) Rev 2/4/2008
0069
DANIEL SHUBERT
JEANNIE SHUBERT
[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 2003 CHAMPION HOMES NA NA 076x027
New /Used Year Manufacturer's Name
050364007455A 050364007455B
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 Pnoperty Address
903 DIAMONDVILLE AVENUE, DIAMONDVILLE, LINCOLN, WY 83116
Street or Route, City, County, State Zip Code
5. The legal description of the Property Address "Land is:
J.FGAT. 11F.SCRTPTT()N ATTACHFn HF.RF.TO ANT) MAT)R A PART HFRPOF
TAX STATEMENTS SHOULD BE SENT TO: WELLS FARGO HOME MORTGAGE, P.O. BOX 11758,
NEWARK, NJ 071014758
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 Affid vit.
7. The Home X 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.
Page 2 Initial:
NMFL 7111 (MAHA) Rev 2/4 /2008
0070
8. The Home shall be assessed and taxed as an impnovement 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 completioninstructioni:
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.
C�-
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.
)he manufacturer's certificate of origin andOor certificate of title to the Home J shall
be [y(J has been eliminated as required by applicable law.
1 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: b. S e
NMFL 7111 (MAHA) Rev 2/4/2008
4,
0071
IN WITNESS WHEREOF, Homeowner(s) has execut this Affidavit in my presence and in the
pres�nce of the undersigned witnesses on this day of
Homeowner #1 (SEAL)
DANIEL SHUBERT
Homeo er #2 (SEAL)
JEANNIE SHUBERT
Homeowner #3 (SEAL)
Homeowner #4 (SEAL)
STATE OF
COUNTY OF
On the
e, the the {1\UP.(
Notary Signature
Notary Public, State of
My Commission expires:
Official Seal:
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.
i
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 4
NMFL 7111 (MAHA) Rev 2/4 /2008
ss.:
day of ��%t. in the year 1 3
a Notary Publjr and and for sakSate, personally appeared
rr
Witness
Witness
Witness
Witness
`-e
Notary Printed Name
Qualified in the County of
SHEt1EY SANDAL!. NOTARY PUBLIC
County of l
SW* of
f.Yroan
EXHIBIT "A"
0073
Lots 2, 3 and 4 of Block 31 to the Town of Diamondville, Lincoln County, Wyoming as described on the official
plat thereof.