Form Tr-64 - Manufactured Or Mobile Home Ownership Affidavit Page 2
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1
2A
’
C
-
FFIANT
S
ERTIFICATION
REQUIRED
I certify the title to this manufactured/mobile home to be free and clear from all defects, liens or encumbrances and
I will indemnify any subsequent purchaser of same for any loss sustained should anyone prove ownership of or lien
holder status in said manufactured/mobile home superior to my title.
I, the undersigned, hereby swear or affirm that I am the owner of the manufactured/mobile home described herein,
of the real estate described in the deeds or mortgage releases attached hereto, if applicable, that there is only one
home located on the described real estate, that the home is permanently affixed to the real estate and the
information provided in this affidavit is true and correct to the best of my belief. I have read and understand the
warning below and therefore am aware that the law provides severe penalties for making false statements under
oath.
Affiant’s
Affiant’s Hand
Signature
Printed Name
Date
W
: K
KSA 21-3711
8,
ARNING
ANSAS STATUTES
PROVIDES THAT FALSIFYING INFORMATION ON ANY REQUIRED DOCUMENT IS A SEVERITY LEVEL
. KSA 21-3710
;
NONPERSON FELONY
DEALS WITH FORGERY
FORGERY IS KNOWINGLY AND WITH INTENT TO DEFRAUD AND IS SEVERITY
8
.
LEVEL
NONPERSON FELONY
Previous versions of this form are subject to requirements listed herein.
TR-64 (02/10)
Current form at:
KS Division of Vehicles will make the final determination if the form is properly completed.
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