Affidavit, Application For Certificate Of Ownership - State Of Nevada - Department Of Business And Industry - Manufactured Housing Division

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STATE OF NEVADA
DEPARTMENT OF BUSINESS AND INDUSTRY
MANUFACTURED HOUSING DIVISION
1830 E. College Pkwy Suite 120, Carson City, NV. 89706
Phone 775-684-2940; Fax 775-684-2949
mhd.nv.gov
AFFIDAVIT, APPLICATION
State of Nevada
FOR CERTIFICATE OF OWNERSHIP
County of _____________________)
The undersigned, ______________________________________________________________________
Mailing Address ______________________________________________________________________
City ________________________________________________________ State ________ Zip________
upon oath states as part of this application to the Manufactured Housing Division, Department of
Business and Industry, for the issuance of a Certificate of Ownership for the structure herein described
as follows:
MAKE: _______________________________ MODEL: ______________________________________
YEAR: ________________________________ SIZE: _________________________________________
SERIAL #_____________________________________________________________________________
That the said structure was obtained on or about the ______ of ___________________, _________
(Day)
(Month)
(Year)
from _________________________________________________________________________________
(Name of Seller or Transferee)
Address _____________________________________ City _____________ State ______ Zip_________,
And that said structure has been in (my, our) possession since that time. At the time (I, we) acquired
this structure, the Certificate of Ownership for this structure was not obtained or is not negotiable for
the following reasons:
______________________________________________________________________________________
______________________________________________________________________________________
That a Certificate of Ownership has been issued in the State of ______________________________.
That said structure is located at: ________________________________________________________.
(Physical location of home)
_____________________________________________________________________________________
(City)
(State)
(Zip)
(I, We) further state that to (my, our) knowledge, the structure is free and clear of any liens,
encumbrances, lawful claims and demands of any person whatsoever, and that the structure is not
involved in any existing or pending litigation, except a lien in favor of
____________________________________________________________________________________
(NAME OF LIENHOLDER – IF NONE, STATE “NONE”)
Lienholder Address __________________________________________________________________
City ___________________________________________________ State _________ Zip __________
Lien is in the sum of $ ___________________
PLEASE COMPLETE page 2

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