SD EForm - 1912
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South Dakota Department of Revenue
Division of Motor Vehicles
Affidavit of Declaration for a Manufactured Home Removed From Real Estate
Location where home was being placed as real estate:
Vehicle Identification Number
We the undersigned hereby give notice to all parties who may be affected or concerned in the premises
and home listed above, that we confirm our intentions to declare this home to be removed as a fixture
from real estate at the location listed above. We further declare our intention to obtain a title in our name
as the rightful owners of the manufactured home. Attached is an independent report indicating that lien
searches have been conducted.
I certify under the penalty of perjury that the above described Manufactured Home is personal property
and, therefore, request a title be issued pursuant to SDCL 32-3.
Signature of Purchaser/Owner
Name and Address of Lienholder
Signature of Lender or authorized agent
Before me, ____________________________________ (Notary Public’s Name), personally appeared
________________________________ (Signing Party/Parties Name(s)), known to me to be the person or persons who is/are
describing in the foregoing instrument, and, being first duly sworn upon his/her/their oath, executed the within instrument,
acknowledged the truthfulness of the representations contained therein, and further acknowledged to me that he/she/they did
so for the purposes set forth therein.
Subscribed and sworn to me before this _____ day of __________________________, 20______.
Signature of Notary Public: ____________________________________
My Commission Expires: _____________________________________
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