Manufactured Home Affidavit For Retirement Of Title Certificate - County Of Beaufort

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STATE OF SOUTH CAROLINA )
)
MANUFACTURED HOME
COUNTY OF BEAUFORT
)
AFFIDAVIT FOR RETIREMENT OF TITLE CERTIFICATE
(1) Name of Owner:______________________________
(2) Description of Manufactured Home:
Date of Manufacture: ________________________
Manufacturer: ____________________________
Model year: _____________
Make: ____________________________________
Width: ________
Length: _______________
Identification Number (VIN): __________________
(3) Check whichever is applicable:
_____The above described manufactured home is not subject to a security lien.
_____The above described manufactured home is subject to a security lien and a separate affidavit, as required by
law, will be filed naming the secured parties.
(4) Check whichever is applicable:
_____The above described manufactured home is located in a jurisdiction with locally enforced building and
safety codes adopted pursuant to Title 6, Chapter 9 and attached to this form is written evidence of compliance with
the applicable codes as of the date the manufactured home was permanently affixed to the above described real
property. Written evidence of compliance includes, but is not limited to, a copy of a certificate of occupancy, a
statement from the code enforcement office, an inspection report, or any documentation of similar effect from the
local code enforcement office having the appropriate jurisdiction.
Only one document should be attached to this form.
_____The above described manufactured home is not located in a jurisdiction with locally enforced building and
safety codes adopted pursuant to Title 6, Chapter 9 applicable to manufactured homes.
(5) Full legal description of the property to which the manufactured home is currently, or is to be, affixed using
metes and bounds or reference to recorded plat by book and page. (A separate sheet identified as ‘Exhibit A’ may be
attached.)
(6) Derivation: This being the identical or a portion of property conveyed or leased to the owner by deed or
lease from _______________________________ and recorded ____________ in Book _______ at page ________.
Tax map number ________________________
Tax billing address ______________________
(7) The above-described manufactured home is permanently affixed or is to be permanently affixed to the
above-described real property and the title certificate is to be retired in accordance with applicable law.
(8) Check if applicable:
______The owner of the manufactured home owns or has a leasehold estate of thirty-five or more years in the
real property to which the manufactured home is affixed.
(9) WARNING: the execution and filing of this affidavit transfers ownership of the manufactured home to the
lawful owner of the real property to which it is affixed.
The owner certifies that the above information provided by the owner is true and correct to the best information
and belief of the owner.
Date:
___________
Signature of owner: ________________________________
Type or print name of owner: _______________________________
Witness: _____________________________
Witness: _____________________________
STATE OF SOUTH CAROLINA
)
COUNTY OF ________________ )
PROBATE
Before me, the undersigned Notary Public, personally appeared ______________________________, who, being
duly sworn, deposed and said that (s)he saw ___________________________________, sign, seal, and deliver the
foregoing Affidavit and that (s)he, together with ____________________________ witnessed the execution thereof.
SWORN to before me this ___ day of _______________ , 20__
Notary Public for_________________(L.S.)
My Commission Expires:_____________

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