Form 78-907 "Affidavit of Destruction" - Mississippi

What Is Form 78-907?

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

Form Details:

  • Released on March 1, 2019;
  • The latest edition provided by the Mississippi Department of Revenue;
  • 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 78-907 by clicking the link below or browse more documents and templates provided by the Mississippi Department of Revenue.

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Download Form 78-907 "Affidavit of Destruction" - Mississippi

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PREPARED BY:
INDEXING INSTRUCTIONS:
_______________________________
_____________________________________
_______________________________
_____________________________________
_______________________________
_____________________________________
_______________________________
_____________________ County, Mississippi
Judicial District: ☐ 1
☐ 2
☐ Not Applicable
Phone: _________________________
st
nd
AFFIDAVIT OF DESTRUCTION
(MANUFACTURED OR MOBILE HOME)
STATE OF MISSISSIPPI
COUNTY OF ___________
BEFORE ME, the undersigned notary public in and for said county and state, appeared [name(s) of each
homeowner signing this affidavit] __________________________________________________________
___________________________________________________________________________________,
known to me (or satisfactorily proven) 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 by personal oath state as follows:
1. Homeowner(s) own(s) the manufactured home or mobile home (“home”) described as follows:
Manufacturer’s Name
Make
Model
Name
Model Year
Manufacturer's Serial No./VIN
Length/Width
New/Used
2. The title to the home was previously retired pursuant to that certain affidavit of affixation recorded:
Date of Recording
Book #
Page #
Instrument #
3. The homeowner(s) executing below is/are all the legal owner(s) of the real property described in the
affidavit of affixation to which the home is/was permanently affixed.
4. The home was destroyed or became uninhabitable on:
Date of Destruction
As a result of (describe cause of destruction)
Affidavit of Destruction
Page 1
Form 78-907-18-1-1-000 (Rev. 03/19)
PREPARED BY:
INDEXING INSTRUCTIONS:
_______________________________
_____________________________________
_______________________________
_____________________________________
_______________________________
_____________________________________
_______________________________
_____________________ County, Mississippi
Judicial District: ☐ 1
☐ 2
☐ Not Applicable
Phone: _________________________
st
nd
AFFIDAVIT OF DESTRUCTION
(MANUFACTURED OR MOBILE HOME)
STATE OF MISSISSIPPI
COUNTY OF ___________
BEFORE ME, the undersigned notary public in and for said county and state, appeared [name(s) of each
homeowner signing this affidavit] __________________________________________________________
___________________________________________________________________________________,
known to me (or satisfactorily proven) 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 by personal oath state as follows:
1. Homeowner(s) own(s) the manufactured home or mobile home (“home”) described as follows:
Manufacturer’s Name
Make
Model
Name
Model Year
Manufacturer's Serial No./VIN
Length/Width
New/Used
2. The title to the home was previously retired pursuant to that certain affidavit of affixation recorded:
Date of Recording
Book #
Page #
Instrument #
3. The homeowner(s) executing below is/are all the legal owner(s) of the real property described in the
affidavit of affixation to which the home is/was permanently affixed.
4. The home was destroyed or became uninhabitable on:
Date of Destruction
As a result of (describe cause of destruction)
Affidavit of Destruction
Page 1
Form 78-907-18-1-1-000 (Rev. 03/19)
This affidavit is executed by homeowner(s) pursuant to applicable state law and shall be recorded in the
official land records in the county, or in the judicial district in counties having more than one such district, in
which the home is located.
Further, affiant(s) sayeth naught.
Printed Name of Homeowner #1
Signature of Homeowner #1
(as shown on title)
Street Address
City
County
State
Zip Code
Printed Name of Homeowner #2
Signature of Homeowner #2
(if more than one; as shown on title)
Street Address
City
County
State
Zip Code
STATE OF MISSISSIPPI
COUNTY OF __________
Subscribed and sworn to before me this ______ day of ____________________, 20____.
__________________________________
(Notary Seal)
Notary Public
My Commission Expires: ______________
ATTENTION CHANCERY CLERK:
Upon receipt of an affidavit of destruction meeting the requirements of Miss. Code Ann. § 63-21-30(7)
and the applicable fee to record the same, you must provide a certified copy of the recorded affidavit to
the homeowner(s) or their authorized representative, if any, and forward a copy of the recorded affidavit
to the county tax assessor in order to assist in removing the home from the tax roll.
Affidavit of Destruction
Page 2
Form 78-907-18-1-1-000 (Rev. 03/19)
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