Free Bureau of Motor Vehicles Letterhead - Indiana

APPLICATION FOR AFFIDAVIT TO TRANSFER TO REAL ESTATE
State Form 51408 (R / 8-07)

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BUREAU OF MOTOR VEHICLES

Home Owner Information Name of Applicant Current Address (number & street, city, state, & ZIP code) County

Return Packet to (Title Company, Bank, etc.) Name Address (number & street, city, state, & ZIP code)

Manufactured Home Information Current Address (number & street, city, state, & ZIP code) County Description of Home

HUD Certification Number Year Name of Manufacturer Serial Number

Real Estate Information Parcel Number Description of Real Estate

Attestation to permanent attachment to real estate of a manufactured home "The manufactured home, aforementioned in this application, is permanently attached to real estate, as described in the legal description of the real estate. I swear or affirm that the information I have entered on this form is correct. I understand that making a false statement on this form may constitute the crime of perjury."

Signature

Printed Name

Date (month, day, year)

Signature

Printed Name

Date (month, day, year)

Notary Certification STATE OF ________________________ COUNTY OF ______________________ } SS: (SEAL) } SS:

Sworn to before me, a Notary Public, in and for said County, this ______ day of __________, 20 ______ _________________________________________________________________________________________________ Printed Name and Signature of Notary Public ____________________________________________________________ Per IC 36-2-11-15(d): "I affirm, under the penalties for perjury, that I have taken reasonable care to redact each Social Security number in this document, unless required by law." Signature Printed Name Date (month, day, year)