765 ILCS 170/5-15 – Affidavit of affixation

(a) An affidavit of affixation shall contain or be accompanied by:
1. (1) the name of the manufacturer, the make, the model name, the model year, the dimensions, and the manufacturer's serial number or numbers of the manufactured home, and whether the manufactured home is new or used;
2. (2)
  1. (A) a statement that the party executing the affidavit is the owner of the real property described therein or (B) if the party executing the affidavit is not the owner of the real property, (1) a statement that the manufactured home is not located in a mobile home park as defined in Section 2.5 of the Mobile Home Park Act and that the party executing the affidavit is in possession of the real property pursuant to the terms of a lease in recordable form that has a term that continues for at least 20 years after the date of execution of the affidavit and (2) the consent of the lessor of the real property, endorsed upon or attached to the affidavit and acknowledged or proved in the manner as to entitle a conveyance to be recorded;
3. (3) the street address and the legal description of the real property to which the manufactured home is or shall be affixed; and
4. (4) as applicable:
  1. (A) if the manufactured home is not covered by a certificate of title, including, if applicable, a certificate of title issued in accordance with subsection (b) of Section 3-109 of the Illinois Vehicle Code, a statement by the owner to that effect, and
    1. (i) a statement by the owner of the manufactured home that the manufactured home is covered by a Manufacturer's Statement of Origin, the date the Manufacturer's Statement of Origin was issued, and the manufacturer's serial number or numbers of the manufactured home; and
    2. (ii) a statement that annexed to the affidavit of affixation is a copy of the Manufacturer's Statement of Origin for the manufactured home, duly endorsed to the owner of the manufactured home, and that the owner of the manufactured home shall surrender the original Manufacturer's Statement of Origin to the Secretary of State; or
  2. (B) if the manufactured home is covered by a certificate of title, including, if applicable, a certificate of title issued in accordance with subsection (b) of Section 3-109 of the Illinois Vehicle Code, a statement by the owner of the manufactured home that the manufactured home is covered by a certificate of title, the date the title was issued, the title number, and that the owner of the manufactured home shall surrender the title to the Secretary of State;
5. (5) a statement whether or not the manufactured home is subject to one or more security interests or liens, and
  1. (A) if the manufactured home is subject to one or more security interests or liens, the name and address of each party holding a security interest in or lien on the manufactured home, including but not limited to, each holder shown on any certificate of title issued by the Secretary of State, if any, the original principal amount secured by each security interest or lien; and a statement that the security interest or lien shall be released; or
  2. (B) a statement that each security interest in or lien on the manufactured home, if any, has been released, together with due proof of each such release;
6. (6) a statement that the manufactured home is or shall be affixed to a permanent foundation;
7. (7) the name and address of a person designated for filing the certified copy of the affidavit of affixation with the Secretary of State, to whom the recording officer shall return the certified copy of the affidavit of affixation after it has been duly recorded in the real property records, as provided in Section 5-25 of this Act; and
8. (8) the certification of a certified residential real estate appraiser, a certified general real estate appraiser, a licensed manufactured home installer, or a licensed professional engineer, as provided in Section 5-5 of this Act.
(b) An affidavit of affixation shall be in the form set forth in this Section, duly acknowledged or proved in like manner as to entitle a conveyance to be recorded, and when so acknowledged or proved and upon payment of the lawful fees therefor, the recording officer shall immediately cause the affidavit of affixation and any attachments thereto to be duly recorded and indexed in the record of deeds.
(c) An affidavit of affixation shall be in the form set forth below:
MANUFACTURED HOME AFFIDAVIT OF AFFIXATION
STATE OF ........................)
)SS.
COUNTY OF .......................)
BEFORE ME, the undersigned Notary Public, on this day personally appeared ......................... (type the name(s) of each person signing this Affidavit) known to me to be the person(s) whose name(s) is/are subscribed below (each a "Homeowner"), and who, being by me first duly sworn, did each on his or her oath state as follows:
1. Homeowner owns the manufactured home ("Home") described as follows:
..................................................................................................................................................
..................................................................................................................................................
(Year; Manufacturer's Name; Manufacturer's Serial No(s).)
2. The street address of the real property to which the Home is or shall be permanently affixed ("Property Address") is:
..................................................................................................................................................
(Street or Route; City; County; State; Zip Code)
3. The legal description of the real property to which the Home is or shall be affixed ("Land") is:..................................................................................................................................................
..................................................................................................................................................
..................................................................................................................................................
..................................................................................................................................................
4. Homeowner is the owner of the Land or, if not the owner of the Land, the Home is not located in a mobile home park, as defined in Section 2.5 of the Mobile Home Park Act, and Homeowner is in possession of the Land pursuant to a lease in recordable form that has a term that continues for at least 20 years after the date of the execution of this Affidavit, and the consent of the lessor is attached to this Affidavit.5. The Home is or shall be assessed and taxed as an improvement to the Land.
6. As of the date of the execution of this Affidavit, or, if the Home is not yet located at the Property Address, upon the delivery of the Home to the Property Address: (a) The Home [ ] is [ ] shall be affixed to a permanent foundation as defined in Section 5-5 of the Conveyance and Encumbrance of Manufactured Homes as Real Property and Severance Act;
(b) The wheels, axles, towbar, or hitch were removed when the Home was placed on the Property Address; and
7. The Home [ ] was [ ] was not permanently affixed before January 1, 2011.
8. If Homeowner is the owner of the Land, any conveyance or financing of the Home and the Land shall be a single transaction under applicable State law.9. The Home is subject to the following security interests or liens:
Name of Lienholder: ....................................................................................................................
Address: ....................................................................................................................................
Name of Lienholder: ....................................................................................................................
Address: ....................................................................................................................................
10. Other than those disclosed in this Affidavit, Homeowner is not aware of (i) any other security interest, claim, lien, or encumbrance affecting the Home or (ii) any other facts or information that could reasonably affect the validity of the title of the Home or the existence or non-existence of security interests in it.11. A release of lien from each of the lienholders identified in paragraph 11 of this Affidavit [] has been [] shall be delivered to the Secretary of State. 12. Homeowner shall initial only one of the following, as it applies to the Home:
[] The Home is not covered by a certificate of title. The Home is covered by a Manufacturer's Statement of Origin, issued on the ...... of .........., ....., manufacturer's serial number ........................, which Homeowner shall surrender to the Secretary of State. A copy of the Manufacturer's Statement of Origin, duly endorsed to Homeowner, is attached to this Affidavit.
[] The Home is covered by a certificate of title issued on the ....... day of .........., ......, title number ........................, which Homeowner shall surrender to the Secretary of State.
13. Homeowner designates the following person to file a certified copy of this Affidavit with the Secretary of State, and the person to whom the Recorder shall return a certified copy of this Affidavit after it has been duly recorded in the real property records: Name: .................................................................................................................................
Address: ..............................................................................................................................
14. This Affidavit is executed by Homeowner pursuant to Section 5-15 of the Conveyance and Encumbrance of Manufactured Homes as Real Property and Severance Act.15. The certification, pursuant to Section 5-5 of the Conveyance and Encumbrance of Manufactured Homes as Real Property and Severance Act, of a certified residential real estate appraiser, a certified general real estate appraiser, a licensed manufactured home installer, or a licensed professional engineer that the home is affixed to a permanent foundation is attached to this Affidavit.
IN WITNESS WHEREOF, Homeowner(s) has/have executed this Affidavit in my presence and in the presence of the undersigned witnesses on this ...... day of ......, ......
...........................(SEAL) ..........................
Homeowner #1 Witness
...........................
Printed Name
...........................(SEAL) ..........................
Homeowner #2 Witness
...........................
Printed Name
...........................(SEAL) ..........................
Homeowner #3 Witness
...........................
Printed Name
...........................(SEAL) ..........................
Homeowner #4 Witness
...........................
Printed Name
STATE OF .........................)
) SS.
COUNTY OF ........................)
The foregoing instrument was acknowledged before me this (date) by (name(s) of person(s) who acknowledged).
.......................... Notary Public
Signature
My commission expires: ...................
Official Seal:
ATTENTION RECORDER: This instrument covers goods that are or are to become fixtures on the Property described herein and is to be filed for record in the records where conveyances of real estate are recorded.

(Source: P.A. 98-749, eff. 7-16-14; 99-166, eff. 7-28-15.)