Form Mv-3014 - Affidavit For The Purpose Of Movement For Disposal Of An Abandoned Mobile/manufactured Home

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SD EForm - 2079
V2
HELP
State of South Dakota
MV-3014
Revised 07/15
Division of Motor Vehicles
445 E. Capitol Avenue Pierre, SD
605-773-3541 |
Affidavit for the Purpose of Movement for Disposal
of an Abandoned Mobile/Manufactured Home
SDCL 21-54-17, 18, 19, 20
A
Mobile/Manufactured Home Information
_
_
Make:_____________________________________ Year:____________
Make/Model
Information
Serial Number: ___________________________________________________
Affiant Name: ______________________________________________________
B
_
_
Address: ____________________________ City _________________ State ____ Zip___________
Real Property Owner
I hereby affirm under oath that I have obtained title to the abandoned home for the sole
purpose of the disposal of the home from real property owned by me and located at
C
_
_
________________________________________________________________________
(Address of physical location of abandoned mobile/manufactured home)
Affirmation for
Disposal Purpose only
I wish to request a moving permit for the sole purpose of disposal ($15 fee.)
Signature of Affiant: _______________________________________ Date: _______________
State of South Dakota
County of: ____________________SS.
Before me,_________________________, personally appeared _________________________
(Notary Public’s Name)
(Signing Party / Parties Name(s))
D
_
known to me to be the person or persons who is/are described in the foregoing instrument and,
_
being first duly sworn upon his/her/their oath, executed the within instrument, acknowledged
Notary
the truthfulness of the representations contained therein, and further acknowledged to me that
he/she/they did so for the purposes set forth therein.
Subscribed and sworn to before me this ____ day of ___________, 20____.
Signature of Notary Public: __________________________________
(Seal)
My Commission Expires: ___________________________________
For County Treasurer Use Only:
________________
__________
Title Surrender Date (90 days from date on affidavit):
(fill in date)
County Staff
Initials
________________
__________
60 day extension requested:
(fill in date)
County Staff
Initials
CLEAR FORM
PRINT FOR MAILING

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