Form 440-5221 "Affidavit in Support of Change to a Manufactured Home" - Oregon

What Is Form 440-5221?

This is a legal form that was released by the Oregon Department of Consumer and Business Services - a government authority operating within Oregon. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • The latest edition provided by the Oregon Department of Consumer and Business Services;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form 440-5221 by clicking the link below or browse more documents and templates provided by the Oregon Department of Consumer and Business Services.

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Download Form 440-5221 "Affidavit in Support of Change to a Manufactured Home" - Oregon

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Affidavit in Support of Change to a Manufactured Home
Department of Consumer and Business Services
Building Codes Division
1535 Edgewater St. NW, Salem, Oregon • Phone: 503-378-4530 • Fax: 503-378-4101
Web: oregon.gov/bcd
HOME INFORMATION
Home ID number (if known):
DMV X-plate number (if known):
AFFIDAVIT INFORMATION
This affidavit can be used to support ownership changes without the applicant being required to submit legal documents
and must be submitted along with a Manufactured Home Ownership Document Application for New and Used Homes
(440-2952) and a valid tax certification, signed by the county in which the home resides.
APPLICANT/OWNERSHIP INFORMATION
Applicant’s name (last, first, middle):
Phone:
Address:
City:
State:
ZIP:
Email:
HOME INFORMATION
Manufacturer:
Year:
Serial number:
HUD label numbers:
I am a co-owner of the manufactured home identified above and am listed with a right of survivorship with (list all
owners) __________________________________________________________________________________________.
I affirm that _______________________________________________________________________________________
is/are deceased and that I possess a copy of the death certificate(s).
I affirm that if the buyer, new owner, or seller is a trust or conservatorship, that I am an authorized representative of
the trust or conservatorship and that I have the legal standing to sign for the trust or conservatorship.
I affirm that, if ownership is transferring because of a divorce, I have been awarded sole ownership of this
manufactured home and possess a copy of the court order with case number ______________ stating that award.
I affirm that I have power of attorney for: _____________________________________________________________
SIGNATURE
I hereby attest that, to the best of my knowledge, this structure is free from all liens and claims of ownership, except as
show in the attached ownership document application. I further attest that the information on this affidavit is true and
correct.
Print name: ____________________________________
Signature: _______________________________________
State of ________________________
County of ________________________
Signed and sworn to (or affirmed) before me on ____________ (date) by _______________________________________
Notary
(Notary seal)
440-5221 (7/17/COM)
Affidavit in Support of Change to a Manufactured Home
Department of Consumer and Business Services
Building Codes Division
1535 Edgewater St. NW, Salem, Oregon • Phone: 503-378-4530 • Fax: 503-378-4101
Web: oregon.gov/bcd
HOME INFORMATION
Home ID number (if known):
DMV X-plate number (if known):
AFFIDAVIT INFORMATION
This affidavit can be used to support ownership changes without the applicant being required to submit legal documents
and must be submitted along with a Manufactured Home Ownership Document Application for New and Used Homes
(440-2952) and a valid tax certification, signed by the county in which the home resides.
APPLICANT/OWNERSHIP INFORMATION
Applicant’s name (last, first, middle):
Phone:
Address:
City:
State:
ZIP:
Email:
HOME INFORMATION
Manufacturer:
Year:
Serial number:
HUD label numbers:
I am a co-owner of the manufactured home identified above and am listed with a right of survivorship with (list all
owners) __________________________________________________________________________________________.
I affirm that _______________________________________________________________________________________
is/are deceased and that I possess a copy of the death certificate(s).
I affirm that if the buyer, new owner, or seller is a trust or conservatorship, that I am an authorized representative of
the trust or conservatorship and that I have the legal standing to sign for the trust or conservatorship.
I affirm that, if ownership is transferring because of a divorce, I have been awarded sole ownership of this
manufactured home and possess a copy of the court order with case number ______________ stating that award.
I affirm that I have power of attorney for: _____________________________________________________________
SIGNATURE
I hereby attest that, to the best of my knowledge, this structure is free from all liens and claims of ownership, except as
show in the attached ownership document application. I further attest that the information on this affidavit is true and
correct.
Print name: ____________________________________
Signature: _______________________________________
State of ________________________
County of ________________________
Signed and sworn to (or affirmed) before me on ____________ (date) by _______________________________________
Notary
(Notary seal)
440-5221 (7/17/COM)