FORM CC-1560 MASTER 10/19
AFFIDAVIT REGARDING MANUFACTURED HOME
Commonwealth of Virginia VA. CODE § 46.2-653.1
In the ..................................................................................................................... Circuit Court
I/We, the undersigned Affiant(s), state under oath that I/we am/are the owner(s) of the manufactured home and the
real property described as follows:
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MANUFACTURER AND, IF APPLICABLE, MODEL NAME OF MANUFACTURED HOME
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VEHICLE IDENTIFICATION NUMBER AND SERIAL NUMBER OF MANUFACTURED HOME
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LEGAL DESCRIPTION OF THE REAL PROPERTY ON WHICH THE MANUFACTURED HOME IS PLACED, INCLUDING THE PROPERTY ADDRESS
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PARCEL IDENTIFICATION NUMBER/TAX MAP NUMBER
[ ] I/We certify that there are no security interests in the manufactured home that have not been released by the secured party.
Complete this section to convert the manufactured home to real property.
[ ] I/We have surrendered the title to the manufactured home to the Department of Motor Vehicles and the title has been
cancelled by the Department of Motor Vehicles. (Attach copy of confirmation provided by the Department of Motor
Vehicles.)
[ ] I/We intend the manufactured home to be a permanent fixture and improvement to the real property described above to
the same extent as any site-built home and to be assessed and taxed with the land as real property.
Complete this section to sever the manufactured home from real property.
[ ] The manufactured home described above has been or will be severed from the real property described above.
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PRINT NAME(S) OF AFFIANT(S) SIGNATURE(S) OF AFFIANT(S)
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DATE
State/Commonwealth of ............................................................................................
[ ] City [ ] County of ...............................................................................................
The forgoing instrument was subscribed and sworn to/affirmed before me this
.................................... day of ............................................................................................... , ..........................
by ..............................................................................................................................................................................................................................................................
PRINT NAME OF SIGNATORY
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[ ] CLERK [ ] DEPUTY CLERK [ ] NOTARY PUBLIC
My commission expires: ........................................................................................
Registration No. ......................................................................................................
