Fillable CERTIFICATE OF DESTRUCTION FOR A MANUFACTURED HOME (Mesa County, Colorado)

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CERTIFICATE OF DESTRUCTION FOR A MANUFACTURED HOME (Mesa County, Colorado)

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CERTIFICATE OF DESTRUCTION FOR A MANUFACTURED HOME
Effective July 1, 2008, the owner(s)/debtor(s) of a manufactured home shall file a Certificate of Destruction for a Manufactured
Home (Certificate of Destruction) after the manufactured home is destroyed, dismantled, sold as salvage, or otherwise disposed of.
Any manufactured home owner/debtor who fails to file a properly completed Certificate of Destruction shall be
responsible for all actual damages sustained by any affected party related to destruction, dismantling, sale for salvage
or disposal of the manufactured home § 38-29-204(4), C.R.S.
Please print or type.
_________________________________________________________________________________________________________
1. Recorded Certificate of Destruction should be returned to: (Name and mailing address)
_________________________________________________________________________________________________________
2. Name(s) and mailing address(es) of owner(s)/debtor(s):
_________________________________________________________________________________________________________
3. Name(s) and mailing address(es) of security interest/lien holder(s):
_________________________________________________________________________________________________________
4. This Certificate of Destruction pertains to the manufactured home identified below:
Serial No.: _______________________________ Certificate of Title/Origin No.: _________________________
(Only if not permanently affixed)
Manufacturer/Make: ________________________ Length/Width: _____________________________________
Year: ____________________________________ HUD No.:_________________________________________
___________________________________________________________________________________________ ___________
5. Is the manufactured home permanently affixed? □ Yes □ No Provide the legal description of the land to which this home is
located (include county name):
Book and page or reception number of recorded Certificate of Permanent Location or Affidavit, if any.______________________
_____________________________________________________________________________________________ _________
6. Property Address (park space if applicable):
Parcel/Schedule No.:
________ _____
7. Name of record owners(s) of land to which the home is permanently affixed - must include at least one owner/debtor listed in
section 2:
________ _____
8. Tax authentication:
Attach to this form the Certificate of Taxes Due or an Authentication of Paid Ad Valorem Taxes issued by the county treasurer of
the county in which the manufactured home is located.
________ _____
9. Consent and lien release:
The undersigned security interest/lien holder(s) consent to the destruction, dismantling, sale for salvage, or disposal of the
manufactured home, and hereby release any lien thereon. (Attach additional sheet if necessary):
_________________________________________________ ________________________________________________
Authorized agent of security interest/lien holder Title Authorized agent of security interest/lien holder Title
_________________________________________________ ________________________________________________
Signature Date Signature Date
State of Colorado State of Colorado
County of ________________________________________ County of ________________________________________
The foregoing was acknowledged before me this ______ day The foregoing was acknowledged before me this ______ day
of______________, 2_____, by the authorized agent of the of _____________, 2_____, by the authorized agent of the
security interest/lien holder named above. security interest/lien holder named above.
Witness my hand and official seal: Witness my hand and official seal:
My commission expires: __________________________ My commission expires: __________________________
_____________________________________________ _____________________________________________
Notary Public Notary Public
If consent of all security interest/lien holder is not secured, attach a notarized declaration as described in
§ 38-29-204(2), C.R.S.
Under penalty of perjury in the second degree, § 18-8-503, C.R.S, the undersigned owner(s)/debtor(s) hereby certify that all
security interest/lien holder(s) are identified on this Certificate of Destruction or any attachments hereto. All owners/debtors consent
to the destruction, dismantling, sale for salvage or disposal of the manufactured home. If the undersigned is a title owner of the
real property, he/she is relinquishing all rights to the manufactured home to be destroyed, § 38-29-204(2)(h), C.R.S.
________________________________________________ _________________________________________________
Signature of owner/debtor Date Signature of owner/debtor Date
Print name __________________________________
Print name _______________________________________
A
ddress _________________________________________ Address _________________________________________
State of Colorado State of Colorado
County of ________________________________________ County of ________________________________________
The foregoing was acknowledged before me this ____ day of The foregoing was acknowledged before me this _____ day of
___________, 2______, by the owner/debtor named above. _____________, 2_____, by the owner/debtor named above.
Witness my hand and official seal: Witness my hand and official seal:
My commission expires: _________________________ My commission expires: __________________________
_____________________________________________ _____________________________________________
Notary Public Notary Public
VERIFICATION THAT ABOVE DESCRIBED MANUFACTURED HOME HAS BEEN DESTROYED, DISMANTLED, SOLD AS
SALVAGE, OR OTHERWISE DISPOSED OF.
___
______________________________________________ _________________________________________________
Authorized Signature/Title Date Print name
15-DPT-AR
MH 303-08/08
Instructions for Completing
Certificate of Destruction for a Manufactured Home
Effective July 1, 2008, the owner(s) of a manufactured home shall record a Certificate of Destruction after
verification the manufactured home is destroyed, dismantled, sold as salvage, or otherwise disposed of.
____________________________________________________________________________________ _______
Section 1: Insert the name and address of the person to whom the county clerk and recorder should return the
Certificate of Destruction.
Section 2: Insert the full legal name and mailing address of each owner/debtor of the manufactured home.
Each owner/debtor must be listed separately. If the home has more than one owner/debtor, attach additional
sheets as necessary.
Section 3: Insert the full legal name and mailing address of each security interest/lien holder of an unsatisfied
security interest or lien against the manufactured home. Each security interest/lien holder must be listed
separately. If the home has more than one security interest/lien holder, attach additional sheets as necessary.
If there is no security interest/lien holder, insert N/A.
Section 4: If the manufactured home is not permanently affixed, insert the Certificate of Origin number or the
Certificate of Title number. The manufactured home serial number manufacturer/make, and the year of
construction must be completed. Include the length and width, and, if available, the HUD number.
Section 5: Insert the legal description of the land to which the home is permanently affixed, including the county
name. If the manufactured home is not permanently affixed, insert the legal location and/or name of the
manufactured home park, including the county name. Insert the book and page number or the reception number
assigned by the county clerk if the Certificate of Permanent Location was recorded.
Section 6: List the property address, including the space number, if applicable. Include the parcel number or
schedule number assigned by the county assessor.
Section 7: (Complete only if the manufactured home is permanently affixed). Insert the full legal name(s) of the
owner(s) of the land to which the home is permanently affixed. At least one manufactured home owner/debtor
shown in section 2 must be an owner of the land to which the home is permanently affixed.
Section 8:
Either the Certificate of Taxes Due or an Authentication of Paid Ad Valorem Taxes issued by the county
treasurer must be attached.
Section 9: Each security interest/lien holder must sign and date the Certificate of Destruction. Each owner/debtor
must also sign and date the Certificate of Destruction.
Notes:
The Certificate of Destruction must
be recorded in the office of the clerk and recorder in the county in which the
manufactured home was located after the destruction, dismantling, sale for salvage or disposal of the
manufactured home has been verified
by an authorized person designated by the governing entity. The clerk and
recorder will provide a copy of the Certificate of Destruction to the county assessor to effect removal of the
manufactured home from the property tax records.
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CERTIFICATE OF DESTRUCTION FOR A MANUFACTURED HOME (Mesa County, Colorado)

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Completed 7 May 2021

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