APPLICATION TO EXEMPT A MANUFACTURED STRUCTURE FROM TITLE AND REGISTRATION
Owner's Certificate of Legal Interest
X PLATE # _________________ EXEMPT FILE # _______________
INSTRUCTIONS: The following must be submitted to DMV:
1)This form, completed and signed by all parties with an interest in the manufactured structure. All areas of the form must be completed.
2)A Title Report or Lot Book Report. (The title report or lot book report cannot be over 7 days old when submitted to DMV.)
3)If the manufactured structure is new and is financed, proof of the loan approval.
4)Proof all taxes for the current tax year have been paid on the manufactured structure. Proof may be a Certificate of Taxes Paid, Form 113, issued by the county where the manufactured structure was located.
PART I LAND
If there is a mortgage, deed of trust or lien on this land, list all mortgagors, beneficiaries of deeds of trust below. Space is provided for two names and addresses. If there are none, write "none."
Name and AddressLoan Number
___________________________________________ _________________
Name and AddressLoan Number
___________________________________________ _________________
Legal description and location of real property; (as recorded by county recorder or a certified copy of your deed may be substituted)
_______________________________________________________________________
_______________________________________________________________________
Property Address
_______________________________________________________________________
Tax Lot Number (from assessor) Map Number Account Number
__________________________ ____________ _____________________
If there is a mortgage, deed of trust or lien on the manufactured structure, list all security interest holders, mortgagees, beneficiaries of deeds of trust, and lien holders whose interest is secured. Space is provided for two names and addresses. Approval signatures are required. If there are none, write "none."
PART II MANUFACTURED STRUCTURE
Legal description of manufactured structure:
Year Make Width Length Vehicle Identification Number(VIN)
____ ____ _____ _____ _____________________________
Name and AddressApproval Signature
________________________________________ x _____________________
Name and AddressApproval Signature
________________________________________ x _____________________
___ I/We do not know the whereabouts of the permanent plate assigned to this vehicle.
PART III OWNER SIGNATURES AND CERTIFICATIONS
I/We certify that the statements made above are accurate to the best of my/or knowledge. All liens, deeds of trust, mortgages and security interests have been listed. If there are none, I/We have certified this by writing "none" in the space provided.
Printed Name of Owners(s)ODL/ID/Customer #Date of BirthTelephone #
_________________________ _______________ _________ ( ___ ) _______
Printed Name of Owners(s)ODL/ID/Customer # Date of BirthTelephone #
_________________________ _______________ _________ ( ___ ) _______
Residence AddressMailing Address
___________________________________________ _______________________
Signature of OwnerSignature of Owner
x __________________________________________ x ______________________
Office use only PART IV Office use only
Application for exemption for a manufactured structure is hereby approved.
Signature DateSignature of DMV Officer
_____________________ _______________________________________________
This exemption is Void if not recorded with the county by this date:
Expiration Date: ______________________
PART V
Official Recording by County Clerk
_____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________
No guidelines are available for this form at this time.