Form Dor 82528 - Affidavit Of Affixture

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AFTER RECORDING RETURN TO:
THIS AREA RESERVED FOR COUNTY RECORDER
AFFIDAVIT OF AFFIXTURE
SEE INSTRUCTIONS ON NEXT PAGE BEFORE COMPLETING
The legal description of the real property located in _________________________________________________________ County,
Arizona, to which the mobile home has been affi xed is:
Assessor’s Parcel #: Book _________ Map ________ Parcel __________
Check if mobile home is in Mobile Home Park:
PROPERTY TAXATION SECTION
The mobile home has
has not
been previously assessed or taxed in Arizona as personal property.
If previously assessed and taxed, give the account number ________________________________________________________,
name and address of person(s) to whom the last tax statement was sent and the location of the mobile home when last taxed.
Name _________________________________________________ Location _____________________________________________
Street Address _______________________________________________________________________________________________
City ___________________________________________________ State _________________________ZIP ___________________
_______________________________________________________
__________________________________________________
Print Complete Name (Seller)
Print Complete Name (Buyer or Owner)
_______________________________________________________
__________________________________________________
Current Address
Current Address
_______________________________________________________
__________________________________________________
Signature
Signature
_______________________________________________________
__________________________________________________
Signature
Signature
The affi ant (owner only) does hereby swear (or affi rm) that the foregoing is a true and correct statement. Subscribed and sworn to
before me this ______________________ day of ____________________, 20_____.
______________________________________________________ My commission expires: _________________________________
Notary Public
ADOT RECEIPT FOR SURRENDERED MOBILE HOME DOCUMENTS
Year ______________ Make ______________________ Manufacturer _________________________________________________
List Price $ ___________________ Size _____________________
Vin Number ______________________________
Vin Number ______________________________
MSO Number(s)
Title Number(s)
Film Number(s)
Vin Number ______________________________
_____________
______________________
________________
Vin Number ______________________________
_____________
______________________
________________
_____________
______________________
________________
________________________________________
Dates Documents Issued
Lienholder Name _____________________________________________________________________________________________
Lienholder Address ___________________________________________________________________________________________
Lienholder Name _____________________________________________________________________________________________
Lienholder Address ___________________________________________________________________________________________
Received by: _______________________________________ __________________________________ Date: _______________
ADOT/Motor Vehicle Division Agent
County
DOR 82528 (02/10)

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