Form Tr-63 - Affidavit Of Permanently Affixed Manufacture/mobile Home And Application To Eliminating Title

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KANSAS
AFFIDAVIT OF PERMANENTLY AFFIXED
MANUFACTURE/MOBILE HOME AND
DEPARTMENT OF REVENUE
DIVISION OF VEHICLES
APPLICATION TO ELIMINATING TITLE
KSA 58-4214
T
MUST
K
D
V
HIS FORM
BE SUBMITTED TO THE
ANSAS
IVISION OF
EHICLES
PRIOR
C
R
D
–
TO BEING SUBMITTED TO THE
OUNTY
EGISTER OF
EEDS
PLEASE READ ALL INSTRUCTIONS
Please Type or Print
Fee: $10.00
Date of Affidavit
M
/M
H
T
I
ANUFACTURED
OBILE
OME AND
ITLE
NFORMATION
:
X
Year
Make
Width
Length
Identification Number
Kansas Title Number
M
/M
H
O
(
) I
ANUFACTURED
OBILE
OME
WNER
S
NFORMATION
(List
A
Owner(s) shown on the Ownership Document)
LL
Name’s of
A
Owners
LL
Address
City
ST
ZIP
L
D
R
P
W
M
/M
H
I
A
(Attach Additional Page if needed.)
EGAL
ESCRIPTION OF
EAL
ROPERTY
HERE
ANUFACTURED
OBILE
OME
S
FFIXED
O
’
C
E
T
WNER
S
ONSENT TO
LIMINATE
ITLE
ALL O
MUST S
.
WNERS
IGN
►
The manufactured/mobile home is subject to a lien:
No
Yes
Lien Holder’s Information and Consent to Eliminate Title MUST be Completed.
I/We, hereby certify and legally state that I/we are the legal owner(s) of the manufactured/mobile home described herein and the legal owner(s) of the
real property where the manufactured/mobile home is affixed. I/we have complied with all laws and requirements, and hereby consent to, and apply
for the elimination of the title for the listed manufactured/mobile home. I/We certify, under penalty of perjury, that all information contained in this
affidavit is true and correct to the best of my/our knowledge.
Owner’s
Signature(s)
Signed and sworn
before me in
Co.,
St., on
Month
Day
Year
.
Notary Seal
Notary Public:
My Commission Expires:
HERE
L
’
I
C
E
T
IEN HOLDER
S
NFORMATION AND
ONSENT TO
LIMINATE
ITLE
Lien Holder’s Name
Address
City
ST
ZIP
I, the undersigned, authorized official of the lien holder listed herein consent to the elimination of the title for the manufactured/mobile home described
herein.
Authorized Official’s Signature
Date
Hand Printed Name of
Position
Person that Signed Above
Title
Signed and sworn
before me in
Co.,
St., on
Month
Day
Year
.
Notary Seal
Notary Public:
My Commission Expires:
HERE
A
A
T
B
F
(M
) T
:
PPROVED
PPLICATION
O
E
ORWARDED
AILED
O
Name
Address
City
ST
ZIP
DO NOT
C
R
D
UNTIL
SUBMIT THIS FORM TO THE
OUNTY
EGISTER OF
EEDS
THIS FORM HAS BEEN COMPLETED BELOW
K
D
V
, T
R
B
.
BY AN AGENT OF THE
ANSAS
IVISION OF
EHICLES
ITLES AND
EGISTRATIONS
UREAU
DO NOT WRITE BELOW THIS LINE-For Division of Vehicles and Register of Deeds Use Only
A
A
T
R
F
R
D
U
O
PPLICATION
PPROVED BY
ITLES AND
EGISTRATIONS
OR
EGISTER OF
EEDS
SE
NLY
B
UREAU
Approved by
Signature:
Position:
Date:
Instructions on the Back of this Form
TR-63 (Rev. 11/08)

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