Illinois mobil home beneficiary affidavit

information known to the party executing the affidavit that could reasonably affect the validity of the title of the manufactured home or the existence or non-existence of a security interest in or lien on it, or (B) that no such facts or information are known to such party; and

(v) the name and address of the person designated for

filing the certified copy of the recorded affidavit of severance with the Secretary of State, to whom the recording officer shall return the certified copy of the affidavit of severance after it has been duly recorded in the real property records, as provided in subsection (d) of this Section.

(b) The affidavit of severance shall be in the form set forth in subsection (d) of this Section, duly acknowledged or proved in like manner as to entitle a conveyance to be recorded, and when so acknowledged or proved and upon payment of the lawful fees therefor, such recording officer shall immediately cause the affidavit and any attachments thereto to be duly recorded and indexed in the record of deeds.
(c) Upon payment of the fees provided by law and recordation of the affidavit of severance, the recording officer shall endorse the affidavit as "recorded in land records", setting forth thereon the indexing information for the recorded affidavit of severance, and the recording officer shall forthwith forward a certified copy of the recorded affidavit of severance to the person designated therein for filing with the Secretary of State. Upon receipt of a certified copy of the recorded affidavit of severance by the person designated therein for filing with the Secretary of State, such person shall deliver for filing to the Secretary of State such certified copy of the affidavit of severance and the other documents provided in subsection (a) of this Section, together with an application for a certificate of title to the manufactured home, to be issued in accordance with subsection (b) of Section 3-109 of the Illinois Vehicle Code.
(d) An affidavit of severance shall be in the form set forth below:
MANUFACTURED HOME AFFIDAVIT OF SEVERANCE
STATE OF . )
)SS.
COUNTY OF . )

BEFORE ME, the undersigned notary public, on this day personally appeared . (type the name(s) of each person signing this Affidavit) known to me to be the person(s) whose name(s) is/are subscribed below (each an "Affiant"), and who, being by me first duly sworn, did each on his or her oath state as follows:

1. The owner(s) of the manufactured home described below

reside(s) at the following address:

Mailing address, if different:
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
(Street or Route; City; County; State; Zip Code)

2. The manufactured home that is the subject of this

Affidavit ("Home") is described as follows:

3. The Home was severed from the following address ("Land"):
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
(Street or Route; City; County; State; Zip Code)

4. An Affidavit of Affixation was duly recorded in the land

records of the county in which the Land is located on (date) . in book number . at page number . 5. Affiant is the owner of the Land or, if not the owner of

the Land, is in possession of the Land pursuant to a lease in recordable form, and the consent of the lessor is attached to this Affidavit.

6. The Home is subject to the following security interests:

Name of Lienholder: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Address: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

7. Other than those disclosed in this Affidavit, Affiant is

not aware of (i) any other security interest, claim, lien, or encumbrance affecting the Home or (ii) any other facts or information that could reasonably affect the validity of the title of the Home or the existence or non-existence of security interests in it.

8. A release of lien from each of the lienholders identified in paragraph 6 of this Affidavit [] has been [] shall be delivered to the Secretary of State. 9. Affiant designates the following person to file a

certified copy of this Affidavit with the Secretary of State, and the person to whom the Recorder shall return a certified copy of this Affidavit after it has been duly recorded in the real property records:

10. This Affidavit is executed by Affiant pursuant to Section

5-50 of the Conveyance and Encumbrance of Manufactured Homes as Real Property and Severance Act.

IN WITNESS WHEREOF, Affiant(s) has/have executed this Affidavit in my presence and in the presence of the undersigned witnesses on this . day of . .
. (SEAL) .
Homeowner #1 Witness
.
Printed Name

. (SEAL) .
Homeowner #2 Witness
.
Printed Name

. (SEAL) .
Homeowner #3 Witness
.
Printed Name

. (SEAL) .
Homeowner #4 Witness
.
Printed Name

STATE OF . )
) SS.
COUNTY OF . )

The foregoing instrument was acknowledged before me this (date) by (name(s) of person(s) who acknowledged).
. Notary Public
Signature

My commission expires: .
Official Seal:

ATTENTION RECORDER: This instrument covers goods that had been fixtures on the Property described herein and is to be filed for record in the records where conveyances of real estate are recorded.
(Source: P.A. 98-749, eff. 7-16-14.)