Multi-Purpose Transfer Form (Page 2 of 2) in pdf

Decal (License) No.(s):

Serial No.(s):

DECLARATION OF INSTALLATION OF WATER HEATER SEISMIC BRACING

I/We the undersigned hereby state that all fuel gas-burning water heater appliances in the manufactured home, mobilehome,

or multifamily manufactured housing described above are seismically braced, anchored, or strapped in accordance with

Health and Safety Code Section 18031.7 and Part 5 of Title 24 of the California Code of Regulations.

YES

Electric water heater is installed per

manufacturer’s instructions.

SIGNATURE ON FRONT SIDE IS CERTIFICATION FOR THIS SECTION

REASON FOR USE TAX AND/OR MOBILEHOME RECOVERY FUND FEE EXEMPTION

Check appropriate box(es):

The above-described unit was a gift. All rights and interest of ownership were transferred without exchange or money or other

valuable consideration.

The above-described unit has been acquired from:

parents, spouse, grandparent(s), grandchild, child, brother(s)*, sister(s)*

The name of a

is being

ADDED

DELETED to the record.

show relationship

The above-described unit was received as the result of an inheritance.

Transfer of the above-described unit is being made pursuant to a court order.

The transfer of the unit is being made to a revocable trust which (1) the seller has an unrestricted power to revoke the trust, (2) the

transfer does not result in any change in the beneficial ownership of the property, (3) the trust provides that upon revocation of the

trust the property will revert wholly to the seller, and (4) the only consideration for the transfer is the assumption by the trust of an

existing loan for which the tangible personal property being transferred is the sole collateral for the assumed loan.

*NOTE: A sale between brother(s) or sister(s) is subject to use tax unless both are minors. If minors, check here:

SIGNATURE ON FRONT SIDE IS CERTIFICATION FOR THIS SECTION

DESIGNATION OF TRUST

I/We, the undersigned trustee(s), hereby state that the unit described above has been placed into a trust. This Declaration of

Trust is dated

In compliance with Section 18080.1(b) of the California Health and Safety Code, I/we as trustee(s) hereby request the unit described

above be registered as shown below. I/We acknowledge that the Department’s permanent title record and the titling documents for the

unit will reflect the information as shown below.

Print Name of the Trust. This is how the name of the Trust will appear on title.

I/We as trustee(s) agree(s) to notify and make application with the Department of Housing and Community Development to

appropriately amend the permanent registration and titling record immediately upon any change to the original trust agreement

described herein by submitting this form along with all appropriate documents, fees or any other needed items to the Department.

I/We as trustee(s) further agree(s) to indemnify and save harmless the Director of the Department of Housing and Community

Development, and subsequent purchasers of said unit, for any loss they may suffer resulting from registration of the above described

unit in California and from issuance of a California Certificate of Title covering the same.

I/We certify under penalty of perjury under the laws of the State of California that the foregoing is true and correct.

Executed on

Date

City

State

Trustee Signature(s):

Street Address or P.O. Box

City

State

HCD RT 476.6G Side 2 (Rev. 07/16)

Multi-Purpose Transfer Form Page 2

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