AFFIDAVIT FOR MANUFACTURED HOME
CONVERSION TO REAL PROPERTY
PURPOSE: Use this form when converting a manufactured home to real property.
INSTRUCTIONS: Return the completed form and title to any DMV customer service center. You may also mail the form and title to the
Titling Work Center at the address above.
NOTE: To ensure a successful conversion to real property, please make certain:
• You own the manufactured home being converted to real property
• The manufactured home does not contain any liens
• You own the property to which the manufactured home is being attached
VSA 35 (08-10-2017)
MANUFACTURED HOME INFORMATION
TITLE NUMBER VEHICLE IDENTIFICATION NUMBER
OWNER INFORMATION
RESIDENCE/HOME ADDRESS (Apt. # if applicable) (if different from above) CITY STATE ZIP CODE
STATE ZIP CODE
STATE ZIP CODE
CITY
CITY
MAILING ADDRESS (if different from above)
CO-OWNER RESIDENCE ADDRESS (if different from above)
OWNER FULL LEGAL NAME (last, first, middle, suffix) DMV CUSTOMER NUMBER / FEIN / SSN
CO-OWNER FULL LEGAL NAME (last, first, middle, suffix) DMV CUSTOMER NUMBER / FEIN / SSN
CERTIFICATION
OWNER SIGNATURE CO-OWNER SIGNATURE
DATE (mm/dd/yyyy) DATE (mm/dd/yyyy)
I/We certify and affirm that the manufactured home described above has had the wheels and other equipment previously used for mobility removed and
has been attached to real property that I/we own. I/We understand that any beneficiary information shown on the title will be removed.
I/We further certify and affirm that all information presented in this form is true and correct, that any documents I/we have presented to DMV are
genuine, and that the information included in all supporting documentation is true and accurate. I/We make these certifications and affirmations under
penalty of perjury and I/we understand that knowingly making a false statement or representation on this form is a criminal violation.
RESIDENCE JURISDICTION (check one) (if different from above)
TOWN ofCITY COUNTY
REGISTRATION NUMBER MY COMMISSION EXPIRES (mm/dd/yyyy)
NOTARY PUBLIC NAME NOTARY PUBLIC SIGNATURE
State/Commonwealth of ______________________, city or county of _____________________________
subscribed and sworn to before me on this ____________ day of ________________________________
(MONTH) (YEAR)
by___________________________________________________ in the city or county and state aforesaid.
NOTARY PUBLIC SEAL
Enter the location of the real property where the manufactured home is attached.
ZIP CODESTATE CITYPHYSICAL ADDRESS OF MANUFACTURED HOME
MANUFACTURED HOME JURISDICTION (check one)
TOWN ofCITY COUNTY
Certain manufactured homes such as "double wides", have multiple title numbers and vehicle identification numbers. Complete the
following only if applicable to the manufactured home you are converting.
TITLE NUMBER VEHICLE IDENTIFICATION NUMBER
TITLE NUMBER VEHICLE IDENTIFICATION NUMBER
NOTARIZATION (must be completed by notary public)
