Form 78-906 "Application for Retirement of a Manufactured or Mobile Home Certificate of Title" - Mississippi

What Is Form 78-906?

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 October 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 78-906 by clicking the link below or browse more documents and templates provided by the Mississippi Department of Revenue.

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Download Form 78-906 "Application for Retirement of a Manufactured or Mobile Home Certificate of Title" - Mississippi

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Form 78-906-19-8-1-000 (Rev. 10/19)
APPLICATION FOR RETIREMENT OF
A MANUFACTURED OR MOBILE HOME CERTIFICATE OF TITLE
 IDENTIFICATION OF MANUFACTURED OR MOBILE HOME
MANUFACTURER’S NAME
MAKE
MODEL NAME
MODEL YEAR
MANUFACTURER’S SERIAL NUMBER/VIN
DIMENSIONS (LENGTH/WIDTH)
HOME IS:
☐ New ☐ Used
 IDENTIFICATION OF OWNER(S)
OWNER(S) NAME
TELEPHONE NUMBER
RESIDENTIAL STREET ADDRESS
CITY
STATE
ZIP CODE
 ATTACH REQUIRED DOCUMENTS
Attached to this application to retire are the following three (3) documents:
☐ Certified copy of Affidavit of Affixation (recorded within 60 days of filing this application); AND
☐ Copy of deed evidencing my/our ownership of the real property to which the home is affixed; AND
One of the following (check only one):
☐ Certificate of Title (duly endorsed and showing release of any liens); or
☐ Manufacturer’s Certificate of Origin (MCO); or
☐ If no Certificate of Title or Manufacturer’s Certificate of Origin, other due proof of ownership (e.g., a bill
of sale, paid tax receipts showing assessment in the name of the owner for a period of not less than
10 years, an installment contract reflecting the serial number or VIN of the home).
 PARTY REQUESTING WRITTEN ACKNOWLEDGEMENT OF SURRENDER
APPLICANT’S NAME
TELEPHONE NUMBER
STREET ADDRESS
CITY
STATE
ZIP CODE
 ACKNOWLEDGMENT
Under the penalties of perjury, I hereby affirm that the information contained in this application is true and accurate.
APPLICANT’S SIGNATURE
NOTARY SEAL
STATE
COUNTY
SUBSCRIBED AND SWORN BEFORE ME ON THIS DATE
BY (CLEARLY PRINT NAME OF PERSON(S) SIGNING)
NOTARY PUBLIC SIGNATURE
MY COMMISSION EXPIRES
Motor Vehicle Services, P.O. Box 1383 Jackson, MS 39215 www.dor.ms.gov Phone 601-923-7200 FAX 601-923-7224
RESET
PRINT
Form 78-906-19-8-1-000 (Rev. 10/19)
APPLICATION FOR RETIREMENT OF
A MANUFACTURED OR MOBILE HOME CERTIFICATE OF TITLE
 IDENTIFICATION OF MANUFACTURED OR MOBILE HOME
MANUFACTURER’S NAME
MAKE
MODEL NAME
MODEL YEAR
MANUFACTURER’S SERIAL NUMBER/VIN
DIMENSIONS (LENGTH/WIDTH)
HOME IS:
☐ New ☐ Used
 IDENTIFICATION OF OWNER(S)
OWNER(S) NAME
TELEPHONE NUMBER
RESIDENTIAL STREET ADDRESS
CITY
STATE
ZIP CODE
 ATTACH REQUIRED DOCUMENTS
Attached to this application to retire are the following three (3) documents:
☐ Certified copy of Affidavit of Affixation (recorded within 60 days of filing this application); AND
☐ Copy of deed evidencing my/our ownership of the real property to which the home is affixed; AND
One of the following (check only one):
☐ Certificate of Title (duly endorsed and showing release of any liens); or
☐ Manufacturer’s Certificate of Origin (MCO); or
☐ If no Certificate of Title or Manufacturer’s Certificate of Origin, other due proof of ownership (e.g., a bill
of sale, paid tax receipts showing assessment in the name of the owner for a period of not less than
10 years, an installment contract reflecting the serial number or VIN of the home).
 PARTY REQUESTING WRITTEN ACKNOWLEDGEMENT OF SURRENDER
APPLICANT’S NAME
TELEPHONE NUMBER
STREET ADDRESS
CITY
STATE
ZIP CODE
 ACKNOWLEDGMENT
Under the penalties of perjury, I hereby affirm that the information contained in this application is true and accurate.
APPLICANT’S SIGNATURE
NOTARY SEAL
STATE
COUNTY
SUBSCRIBED AND SWORN BEFORE ME ON THIS DATE
BY (CLEARLY PRINT NAME OF PERSON(S) SIGNING)
NOTARY PUBLIC SIGNATURE
MY COMMISSION EXPIRES
Motor Vehicle Services, P.O. Box 1383 Jackson, MS 39215 www.dor.ms.gov Phone 601-923-7200 FAX 601-923-7224