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Affidavit of Affixation

An affiant who executes this affidavit confirms that s/he owns the constructed home and this home shall be permanently affixed to his/her real estate records. Moreover, affiant affirms the following additional information: (1) home is characterized by site-built housing features; (2) home is part of the land; (3) home’s construction is compliant with the Federal Manufactured and Home Construction and Safety Standards Act; and (4) home shall be taxed and assessed as a form of improvement to the land. As executing the affidavit subjects the affiant to the penalties of perjury, affiant must confirm that the information stated in the affidavit are true and accurate to the best of his/her knowledge.

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Grantor or Grantee 	 	Date (MM/DD/YYYY)	
 	__ __ /__ __ /__ __ __ __	
Name of Manufactured Homeowner
Street Address Where the Manufactured Home is or will be Located	 	City	 	State	  	Zip	
(Space Above Reserved for Recorder of Deeds Certification)	
Real Estate Information	
Legal Description of Real Estate (Attach a separate exhibit if more spa\
ce is needed) Page 1 of 3	
Manufactured 
Home Information	
Manufacturer Name	 	Manufacturer’s Serial Number of the Manufactured Home	  	Home is:	
    	r	 New	
     	r	 Used 	
Model Year	 	Make	 	Model Name	  	Dimensions of the Home	
    Form
5312	
Missouri Department of Revenue
Affidavit of Affixation	
Form 5312 (Revised 08-2014)

Surrendered Ownership Document Information	
Place your initials in the box that applies to the type of ownership document currently in your possession. If you  
do not possess an ownership document, indicate so in the appropriate are\
a provided below:
If you possess a Manufacturer’s Certificate of Origin (MCO) or Manu\
facturer’s Statement of Origin (MSO) 
 	 The manufactured home is currently covered by a MCO or  MSO. I am surrendering the original MCO  	
   	or MSO.  Provide the following from the MCO or MSO:	
   	Manufacturer’s Serial Number ________________________________________\
____________  	
   	MCO or MSO Issue Date (MM/DD/YYYY) 	__ __ /__ __ /__ __ __ __	
 	The 	original MCO or MSO must be surrendered to the Director of Revenue with Application	 for Surrender of Title  	
 	or Manufacturer’s Certificate of Origin (MCO), (	Form 5315).
If you possess a Certificate of Title 	
 	 The manufactured home is currently covered by a certificate of title. I \
am surrendering the title to   	
  	the aforementioned manufactured home. Provide the following from the tit\
le document:	
   	Title Number 	__________________________________________________________________ 	
   	Title Issue Date (MM/DD/YYYY) 	__ __ /__ __ /__ __ __ __	
 	The original title must be surrendered to the Director of Revenue with Application for Surrender of Title or   	
 	Manufacturer’s Certificate of Origin (MCO), (	Form 5315).
If you are unable to locate either the MCO, MSO or Certificate of Title \
	
 	 A certificate of title does not exsist, or I am unable to locate the ori\
ginal MCO, MSO or certificate of title	 	
   	af	 ter diligently searching for such documents. You must complete an Application for Confirmation of 	 	
   	Conversion (	Form 5314) and provide it to the director of revenue.	
Page 2 of 3	
  I hereby state the following: (place initials in applicable boxes)
 	 I am the owner of the real estate described in this affidavit; or,	
 	 I am in possession of the real estate under the terms of a lease in reco\
rdable form that has a term that	 	
   	co	 ntinues for at least 20 years after the date of execution of this affidavit. If you have initialed this	 	
   	box, the Lessor 	must complete the Consent of Lessor section below .	
Consent of Lessor	
I am the owner of the real estate where the manufactured home described in this affidavit has been permanently   
affixed and the owner of the manufactured home has entered into a lease for such real estate for a period of at least 
twenty (20) years after the date of the execution of this affidavit, I hereby consent to the affixation of this manufactured 
home to the real estate.
_____________________________________________  
Lessor Signature
_____________________________________________
Printed or Typed Name of Lessor
(Seal)	State of Missouri	 	)	  
 	)	  
County of __________________________)
Subscribed and sworn before me this
___________________ day of _________________________, 20 _____
_________________________________________________________
Notary Signature
_________________________________________________________
Printed or Typed Name of Notary  
My Commission Expires ______________________________________	
Form 5312 (Revised 08-2014)

Page 3 of 3	
Will receive written acknowledgement of compliance.
Name of Designated Agent	 	Business or Agency Name	
Street Address	 	City	 	State	  	Zip	
Designated Agent 
for Filing	
Provide the security interest or lienholder information below (if more \
than two use an additional sheet):
________________________________________________________________________\
___________________________________	 	 ___________________________	Lienholder Name	   	Original Principal Amount	
____________________________________________________________________________________________________________________________________________Address
________________________________________________________________________\
___________________________________	 	 ___________________________	Lienholder Name	  	Original Principal Amount	
____________________________________________________________________________________________________________________________________________Address
Place your initials in the box(es) that applies:
 	 The manufactured home described in this affidavit is subject to one or more security interests or liens	 	
   	identified above which will be released upon satisfaction of the terms o\
f the security agreement entered	  	 	
   	between the owner and lienholder.	
 	 The security interest or lien identified above has been released and a c\
opy of the release of security	 	
   	interest or lien will be attached to the copy of the recorded Affidavit \
of Affixation that will be filed with the 	 	
   	Director of Revenue.	
Security Interest and Lienholder Information	
Form 5312 (Revised 08-2014)	
Consent of Affiant	
Under penalties of perjury, I	 hereby 	affirm that the manufactured home described herein is or shall be permanently	 
affixed to the real estate described herein, the home has the characteri\
stics of site-built housing and is part of the  
land, the home was built in compliance with the federal Manufactured Home Construction and Safety Standards 
Act, and the home is or shall be assessed and taxed as an improvement to the land. I further affirm to the best of 
my knowledge that the information contained in this affidavit is true an\
d accurate based on the attached documents.	
___________________________________________	 	___________________________________________  	Affiant’s Signature	 	Printed or Typed Name of Affiant
(Seal)
State of Missouri	 	)	  
 	)	  
County of __________________________)
Subscribed and sworn before me this
___________________ day of _________________________, 20 _____
Notary Signature 	
 ___________________________________________	
Printed or Typed Name of Notary	 ______________________________	
My Commission Expires ______________________________________	
Present this completed form to your local license office or mail it with\
 the appropriate fees to:	 	
 	Motor Vehicle Bureau	  	P.O. Box 100	 	Phone: 	(573) 526-3669	  	
 	Jefferson City, MO 65105-0100	  	E-mail:  [email protected]	Visit http://dor.mo.gov/motorv/homes/
for additional information.
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