Fillable Form 22: AdavitofAxtureofMobileHome MichiganDepartmentofLicensingandRegulatoryAairs BureauofConstructionCodes/OceofLandSurveyandRemonumentation P.O. Box 30255, (Michigan)

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Form 22: AdavitofAxtureofMobileHome MichiganDepartmentofLicensingandRegulatoryAairs BureauofConstructionCodes/OceofLandSurveyandRemonumentation P.O. Box 30255, (Michigan)

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The Form 22: AdavitofAxtureofMobileHome MichiganDepartmentofLicensingandRegulatoryAairs BureauofConstructionCodes/OceofLandSurveyandRemonumentation P.O. Box 30255, (Michigan) form is 2 pages long and contains:

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Country of origin: US
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AdavitofAxtureofMobileHome
MichiganDepartmentofLicensingandRegulatoryAairs
BureauofConstructionCodes/OceofLandSurveyandRemonumentation
P.O. Box 30255, Lansing, MI 48909
E-Mail:
BCCOLSR@michigan.gov
/Phone:517-241-6321
Authority:1987PA96
□ApplicationFee: $90.00
22
Instructions:
•SubmittheORIGINALapplicationsignedbeforeanotary.
•RemitacheckormoneyordermadepayabletotheStateofMichigan.
•Securityinterest(s)ofrecordmustgivewrittenconsenttotheterminationofthe
security interest and the cancellation of the certificate of title.
•Applicationwillbereturnedifnotcomplete.
•The ORIGINAL Certificate of Title or Certificate of Origin must accompany
thisapplication(fornewapplicationsonly).Theowner(s)ontheAdavitof
Axturemustmatchtheowner(s)onthetitle/origin.
•Once approved, the original will be returned to the person listed on page 2,
otherwise it willbe returnedto theowner. It must then be recorded with the
RegisterofDeedsforthecountyinwhichtherealpropertyislocated.
ForDepartmentUseOnly
FILEDANDACCEPTEDBYTHEDEPARTMENTON
OwnerandMobileHomeInformation
NameofOwner(s) E-Mail Address
Property Address
City
MICHIGAN
Zip Code
Year Manufacturer Manufacturer’sSerialNo.
Providelegaldescriptionoftherealpropertytowhichthemobilehomeisaxed
□Attachment enclosed
Icertifythemobilehomeisaxedtotherealpropertydescribedabove.
SignatureofOwner(s)asListedAbove Date
NameofOwner(s)asListedAbove(TypeorPrint)
ThisadavitwasexecutedintheCountyof_____________________withintheStateof_______________________.
Subscribedandsworntoby________________________________________________beforeme,this______dayof
_______________________________,20______.
ANotaryPublicinandfor_______________________________County,withintheStateof_____________________.
SignatureofNotaryPublic_______________________________PrintedName_______________________________
MyCommissionexpireson______________________________________________
BCC-961(Rev.11/17)Page1 OVER
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CurrentSecuredPartiesofRecord
1stSecuredParty
Address
City State Zip Code
Iherebygiveconsenttotheterminationofthesecurityinterestandthecancellationofthecerticateoftitle.
SignatureofAuthorizedRepresentative Date
2ndSecuredParty
Address
City State Zip Code
Iherebygiveconsenttotheterminationofthesecurityinterestandthecancellationofthecerticateoftitle.
SignatureofAuthorizedRepresentative Date
DraftedBy
Name
Address
City State Zip Code
ReturnAdavitofAxtureto:
Name
Contact Person TelephoneNumber(IncludeAreaCode)
Address
City State Zip Code
LARAisanequalopportunityemployer/program.Auxiliaryaids,servicesandotherreasonableaccommodationsareavailableuponrequesttoindividualswithdisabilities.
VALIDATIONAREA
BCC-961(Rev.11/17)Page2
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Form 22: AdavitofAxtureofMobileHome MichiganDepartmentofLicensingandRegulatoryAairs BureauofConstructionCodesOceofLandSurveyandRemonumentation P.O. Box 30255, (Michigan)

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Completed 20 August 2020

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