Form 5312 - Affidavit Of Affixation
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(Space Above Reserved for Recorder of Deeds Certification)
MISSOURI DEPARTMENT OF REVENUE
FORM
5312
MOTOR VEHICLE BUREAU
AFFIDAVIT OF AFFIXATION
Page 1 of 3
(REV. 3-2011)
Grantor/Grantee
Date
Name of Manufactured Homeowner
Street Address Where the Manufactured Home is or will be Located
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)
DOR-5312 (3-2011)
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