Affidavit, Application For Certificate Of Ownership - State Of Nevada - Department Of Business And Industry - Manufactured Housing Division Page 2

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STATE OF NEVADA DEPARTMENT OF BUSINESS & INDUSTRY
MANUFACTURED HOUSING DIVISION
AFFIDAVIT, APPLICATION FOR CERTIFICATE OF OWNERSHIP
Page 2 of 2
That (I, we) have good right and lawful authority to request the Division to issue a Certificate of
Ownership on said structure to:
NEW REGISTERED OWNER
NEW LIENHOLDER
(Please include vesting i.e. “or”, “and”, “jtwros”)
_______________________________________
___________________________________________
_______________________________________
___________________________________________
Mailing Address:_______________________
Mailing Address: ___________________________
_______________________________________
___________________________________________
The statements and declarations herein contained are for the specific purpose of inducing said Division
to issue a Certificate of Ownership; that (I, we) shall and will assume, fully pay, satisfy and discharge
any and all liens, claims or encumbrances disclosed herein or any others that may be shown or proved
to be upon or against said structure and indemnify and save harmless said Division and the State of
Nevada on account of the issuance of said Certificate of Ownership on said structure as aforesaid.
(I, We) hereby certify under penalty of perjury that the foregoing is true and correct.
IN WITNESS WHEREOF, this instrument has been executed this ________________ day of
_____________, _____________.
(Day)
(Month)
(Year)
Signature _______________________________________________
Signature _______________________________________________
STATE OF ___________________
COUNTY OF _____________________
This instrument was acknowledged before me, ______________________________the undersigned
(Name of Notary Public)
Notary Public, on this ________ day of _____________, 20______
by_________________________________ and__________________________________________
(Name of Signer)
(Name of Signer)
___________________________________
Notary Public Signature
**WARNING: Endorsement required by county assessor where mobile home is situated that
all taxes have been paid before title can be transferred.**
____________________________________________
For Tax Year __________________
Signature of County Assessor
(Revised 06/2014)

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