HomeMy WebLinkAbout904037MANUFACTURED HOME
AFFIDAVIT OF AFFIXATION
9 0 h 0 3
STATE OF WYOMING )
) SS.:
COUNTY OF Lincoln )
RECEIVED
LINCOLN COUNTY CLERK
BEFORE ME, the undersigned notary public, on this day personally appeared
ROGER D. SMITH
[type the name(s) of each Homeowner signing this Affidavit]:
known to me to be the person(s) whose name(s) is/are subscribed below (each a "Homeown ~r"), and who, being by me
first duly sworn, did each on his or her oath state as follows:
1. Homeowner owns the manufactured home ("Home") described as follows:
USED '1995 KIT G95 79Z18 14686 66.8 X 26.9
New/Used Year Manufacturer's Name Model Name and Model No. Manufacturer's Serial No. Length / Width
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 (ivl the
formaldehyde health notice.
4. The Home is or wil be located at the following ~Property Address":
1148 COAL CREEK DRIVE DIAMONDVILLE LINCOLN WY 83116
Street or Route City County State Zip Code
5. The legal description of the real property where the Home is or will be permanently affixed ("Land") is:
LOTS 14 AND 15 OF SOUTHLAND PARK, TOWN OF DIAMONDVILLE,L/NCOLN COUNTY,
WYOMING AS DESCRIBED ON THE OFFICIAL PLAT THEREOF.
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 [] 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.
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 Property
Address. 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 man ufacturer's warranty.
(c) The wheels, axles, towbar or hitch were removed 'when the Home was or will be, placed on the Property
Address;
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0904037
(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; and
(e) The Home is permanently connected to a septic tank or sewage system and other utilities such as electricity,
water and natural gas.
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 applicant 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:
[ ] 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.
[ ] 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 certificate of title to the Home [] shall be [] has been eliminated as required by applicable law.
[ ] The Home shall be covered by a certificate of title.
13. The Homeowner designates the following person to record this Manufactured Home Affidavit of Affixation and upon
its recording it shall be returned by the recording officer in the real property records where the home is to be located
to same:
Name: WFHM
Address: 3601 MINNESOTA DP,, STE 200, BLOOMINGTON, MN 55435
14. This Affidavit is executed by Homeowner(s) pursuant to applicable state law.
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09040 ?
WITNESS WHEREOF, Homeowner(s) has executed this Affidavit in my presence and in the presence of the
ed witnesses on this ],8th
~OGER D. SMITH
'rinted Name
day of October ., 2004 ·
0 614
(SEAL)
Witness
{omeowner #2
(SEAL)
Witness
'rinted Name
Iomeowner ~
(SEAL)
Witness
'rinted Name
;TATE OF WYOMING )
) SS.:
;OUNTY OF Lincoln )
On the 18th day of October ir~ the year 2004 before
ne, the undersigned, a Notary Public in and for said State, personally appeared
Ro~er D. S~n'l
~ersonally known to me or proved to me on the basis of satisfactory evidence to be the individual(s) whose name(s)
s(are) subscribed to the within instrument and acknowledged to me that he/she/they executed the same in
ds/hedtheir capacity(les), and that by his/her/their signature(s) on the instrument, the individual(s), or the person on
)ehalf of which the individual(s) acted, executed the instrument.
,Iotary Printed Name
~otary Public; State of
)ualified in the County of
,,ly commission expires:
}fficial Seal:
Wyoming
Lincoln
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Lender's Statement of Intent:
The undersigned ("Lender")
improvement to the Land.
intends
that the Home be an
immoveable
fixture
[ ;
and a permanent
0615
COMMUNITY FIRST MORTGAGE, LLC
Lender
By:
Authorized.~ignatur~
STATE OF NORTH DAKOTA
COUNTY OF CASS
)
) SS.:
)
On the 18th day of October in the year 2004 before
me, the undersigned, a Notary Public in and for said State, personally appeared
E _A TI-IV gTOPPT,F,R
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.
Lynette Grove
Notary Printed Name
Notary Public; State of North Dakota
Qualified in the County of Cass
My commission expires: March 23~ 2010
Official Seal:
~ Notary Public ~
~ State of Nodh Dakota [
~E_xpires Mar. 23, 2010[
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 conveyances of real estate are recorded.
Drafted By: COMMUNITY FIRST MORTGAGE, LLC
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