Form Mv-004 - Affidavit Of Declaration For A Manufactured Home Placed On Real Estate
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1SD EForm -
2078 V1
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South Dakota Department of Revenue
Division of Motor Vehicles
MV-004 03/10
Affidavit of Declaration For a Manufactured Home Placed on Real Estate
Purchaser/Owner:
_____________________________________________________________
Location where home is being placed as real estate:
_____________________________________________________________
Address
City
State
Zip Code
_____________________________________________________________________________________
Legal description
Manufactured Home:
_____________________________________________________________
Vehicle Identification Number
Year
Make
Model
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 a fixture to real estate
at the location listed above. We further declare the title to such home is hereby surrendered and said
property shall be treated as mortgaged property and subject to the requirements thereof.
I certify under the penalty of perjury that the above described Manufactured Home is real property and,
therefore, should not be issued a certificate of title pursuant to SDCL 32-3.
______________________________
_______________________
Signature of Purchaser/Owner
Date
______________________________________________________________________________________
Name and Address of Lienholder
_________________________________________
_______________________________
Signature of Lender or authorized agent
Date
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______.
(SEAL)
Signature of Notary Public: ____________________________________
My Commission Expires: _____________________________________
Copy: ROD
DOE
1.
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