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.