Form Tr-62 - Valueless Mobile/manufactured Home (Mh) Affidavit

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VALUELESS

KANSAS

DEPARTMENT OF REVENUE

MOBILE/MANUFACTURED HOME (MH)

DIVISION OF VEHICLES

AFFIDAVIT

Please Type or Print Clearly

Mobile Home

Park Owner’s Name

Name of Mobile

Home Park

, located at:

Address

City

ZIP

MOBILE HOME INFORMATION

Year

Make

VIN

Mobile/Manufactured

Home Owner’s Name

Name of MH

Lienholder

Date MH was

Lien Notice

MH was

Abandon or Surrendered

was Posted

Removed on

Approximate Value of MH

Reasonable Cost of Disposal and

& Personal Property $

All Sums Owed to Mobile Home Park

MH was

Removal to Demolisher, Sanitary Land

Removed by Disinterested

Disposed of By:

Fill or other Lawful Disposal Site

Third Party for No Consideration

New Owner/Disinterested

Party’s Name

, of

Address

City

ZIP

I, the undersigned, hereby certify that I am the owner of the mobile home park, as defined in KSA 58-25,103, located in the State of Kansas at the address shown

above. As required by KSA 58-25,121(c), the tenant did provide me, in writing, the mobile/manufactured home’s year, make and serial number, if there was a lien and

if so, the name and address of the lienholder and the name and address of the legal owner. The mobile/manufactured home tenant was absent without reasonable

explanation for 30 days or more from the date of abandonment or surrendered shown above. I did cause a written notice of my lien to be posted conspicuously upon

the mobile/manufactured home on the date shown on this affidavit. The legal owner and known lienholder were notified by registered mail of the abandonment and

the liability for any cost incurred for the mobile/manufactured home space, including rent and utilities due and owing. I further certify that the information contained on

this affidavit is true and correct, that the supporting documentation listed on this affidavit has been attached and that all requirements and laws have been complied

with.

By my signature I swear or affirm that this is a true and correct statement. I am aware that the law provides severe penalties

for making false statements under oath.

Mobile Home Park

Owner’s Hand Printed Name

Mobile Home Park

Owner’s Signature

Date

SEE REVERSE SIDE FOR INSTRUCTIONS

Original-Submit to County Treasurer

2nd Copy-To Party Disposing of MH

3rd Copy-Mobile Home Park Owner