Form 5313 - Affidavit Of Severance
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(Space Above Reserved for Recorder of Deeds Certification)
FORM
MISSOURI DEPARTMENT OF REVENUE
5313
MOTOR VEHICLE BUREAU
AFFIDAVIT OF SEVERANCE
(REV. 2-2011)
Page 1 of 2
Grantor/Grantee
Date
Name of Manufactured Homeowner (Person(s) who will be issued Certificate of Title)
Residential Address
City
State
Zip
Mailing Address
City
State
Zip
MANUFACTURED HOME INFORMATION
Manufacturer Name
Manufacturer’s Serial Number of the Manufactured Home
Home is:
New
Used
Model Year
Make
Model Name
Dimensions of the Home
REAL ESTATE INFORMATION
Legal Description of Real Estate (Attach a separate exhibit if more space is needed)
RECORDATION INFORMATION
(Obtain from Recorder of Deeds)
Date Affidavit of Affixation was Recorded with Recorder of Deeds Book Number
Page Number
DOR-5313 (2-2011)
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