Form 169 - Affidavit Of Affixture And Notice Of Lost Or Destroyed Title - Utah Housing Corporation

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UHC Form 169
Rev. 11/17
Page 1 of 1
When recorded mail to:
Utah Housing Corporation, Mtg. Banking
2479 South Lake Park Blvd, West Valley City, UT 84120
UTAH HOUSING CORPORATION
AFFIDAVIT OF AFFIXTURE AND NOTICE OF LOST OR DESTROYED TITLE
I, _____________________________, being first duly sworn, do hereby depose and say:
(owner/seller)
1. I am a resident of__________________ County, State of Utah, and I have personal knowledge of the facts
contained in this Affidavit and I am making this Affidavit to comply with Utah Code Ann. Section 70D-2-401.
2. I own a fee simple interest in the following described property (“Real Property”) located
at____________________________, _____________________, __________________County,
Address
City
State of Utah, more particularly described as (legal description):
3. I own a manufactured home (“the Home”) described by the manufacturer’s identification number(s):
Data Plate Numbers, HUD tag and/or other manufacturer’s identifying number (HUD Certification Label
Numbers):
_______________________________,
_____________________________ and
Manufactures Serial or Vehicle Identification Number (“VIN) #: ________________________________and
The Home: Year________,_Make_________________________________, Model______________________
4. The Home is permanently affixed to the Real Property
5. The Home is not registered with the Utah Motor Vehicles Division
6. The Home is taxed as an improvement to real estate by the _______________________County
assessor as permitted under Utah Code Ann. Section 59-2-1503.
7. The Certificate of Title for the Home has been lost or destroyed and I am unable to secure a duplicate title.
Dated this ____________ day of _______________20____
____________________________________
____________________________________
Owner /Seller of Property
Co-Owner/Seller of Property
State of Utah
County of _________________________
The foregoing instrument was acknowledged before me this ____________day of _____________,20____ by
____________________________________________________________________________
___________________________________________
Notary Public
My Commission Expires:________________

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