S.C. Code Ann. § 56-19-540
(B) The Manufactured Home Lien Affidavit must be in the following form:
(2) Description of Manufactured Home: ______
Date of Manufacture: ___________________
Manufacturer: __________________________
Model year: _________________ Make: ____
Width: _________________ Length: _______
Identification Number (VIN): ___________
(3) The above described manufactured home is subject to a security lien and all secured parties with mailing addresses are listed below:
_________________________________________________________
_________________________________________________________
(4) Full legal description of new property to which manufactured home is to be affixed using metes and bounds or reference to recorded plat by book and page. (A separate sheet identified as "Exhibit A" may be attached.)
___
(5) Derivation: This being the identical or a portion of property conveyed or leased to the owner by deed or lease from __________________________________________ and recorded ______________ in Book _______ at page _____________________.
Tax map number______________________
Tax billing address__________________________________________
(6) Name of owner of real property if different from owner of manufactured home.
_________________________________________________________
(7) The owner of the manufactured home affidavit was recorded on ____________________, in book _____________, at page __________________, in the County of ___________________.
The owner certifies that the above information provided by the owner is true and correct to the best information and belief of the owner.
Date: ____________________ ___________________________
Signature of Owner
___________________________
Type or print name of owner
Witness: _________________
Witness: _________________
STATE OF SOUTH CAROLINA )
COUNTY OF __________________ ) PROBATE
Before me, the undersigned Notary Public, personally appeared ______________________________, who, being duly sworn, deposed and said that he saw ___________________________________, sign, seal, and deliver the foregoing Affidavit and that he, together with ____________________________ witnessed the execution thereof.
______________________________
SWORN to before me this
_________ day of _______________
Notary Public for________________(L.S.)
My Commission Expires:________
STATE OF SOUTH CAROLINA ) MANUFACTURED HOME
) LIEN AFFIDAVIT
COUNTY OF _______________ )
HISTORY: 2003 Act No. 88, Section 2.