765 ILCS 170/5-50
(a) If and when a manufactured home for which an affidavit of affixation has been recorded is detached or severed from the real property to which it is affixed, the person (all, if more than one) having an interest in the real property shall record an affidavit of severance in the land records of the county where the affidavit of affixation with respect to the manufactured home is recorded. The affidavit of severance shall contain or be accompanied by:
(d) An affidavit of severance shall be in the form set forth below:
MANUFACTURED HOME AFFIDAVIT OF SEVERANCE
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 an "Affiant"), and who, being by me first duly sworn, did each on his or her oath state as follows:
1. The owner(s) of the manufactured home described below reside(s) at the following address:
..................................................................................................................................................
(Street or Route; City; County; State; Zip Code)
Mailing address, if different:
..................................................................................................................................................
(Street or Route; City; County; State; Zip Code)
2. The manufactured home that is the subject of this Affidavit ("Home") is described as follows:
..................................................................................................................................................
(Year; Manufacturer's Name; Manufacturer's Serial No(s).)
3. The Home was severed from the following address ("Land"):
..................................................................................................................................................
(Street or Route; City; County; State; Zip Code)
4. An Affidavit of Affixation was duly recorded in the land records of the county in which the Land is located on (date) ............., in book number ...... at page number .....5. Affiant is the owner of the Land or, if not the owner of the Land, is in possession of the Land pursuant to a lease in recordable form, and the consent of the lessor is attached to this Affidavit.6. The Home is subject to the following security interests:
Name of Lienholder: ....................................................................................................................
Address: ....................................................................................................................................
Name of Lienholder: ....................................................................................................................
Address: ....................................................................................................................................
7. Other than those disclosed in this Affidavit, Affiant 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.8. A release of lien from each of the lienholders identified in paragraph 6 of this Affidavit [] has been [] shall be delivered to the Secretary of State. 9. Affiant 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: ..............................................................................................................................
10. This Affidavit is executed by Affiant pursuant to Section 5-50 of the Conveyance and Encumbrance of Manufactured Homes as Real Property and Severance Act.
IN WITNESS WHEREOF, Affiant(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 had been 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.)