The form of the collateral list and a supplement for mobile or manufactured homes must be substantially as follows:

Collateral List For __________________________ County

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Lienholder: ______________________________________

Address for Notice: _______________________________

Date: ________________________

Name(s) of Owner(s): Address of Home: _______________

Other Address of Owner(s): _______________________

Zip Code: ___________________

Year of Home: _______________

Make/Model: _________________

Size of Home: _______________

Full Serial Number: ____________.