Mhd Form 1023 - Application For Statement Of Ownership And Location

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T
D
H
C
A
EXAS
EPARTMENT OF
OUSING AND
OMMUNITY
FFAIRS
M
H
D
ANUFACTURED
OUSING
IVISION
P. O. BOX 12489 Austin, Texas 78711-2489
(800) 500-7074, (512) 475-2200 FAX (512) 475-1109
Internet Address:
APPLICATION FOR STATEMENT OF OWNERSHIP AND LOCATION
The filing of an application for the issuance of a Statement of Ownership and Location, later than sixty (60) days after the date of a sale to a consumer for residential
use, may result in a fee of up to one hundred dollars ($100). Any such application that is submitted late may be delayed until the fee is paid in full.
BLOCK 1: Transaction Identification
Coding:
(For Department Use Only)
Type of Transaction
Regular or Priority Handling
Personal Property Transaction
Real Property Transaction
Regular Handling
Completed applications will be processed
Lien on file: Y
/
N
New
New
within 15 working days from date received.
Lienholder Code
Used
Used
County Code:
Priority Handling Requested
Lien Assignment
Update SOL
An additional $55 fee is included with
Right of Surv.:
Y
/
N
Other:__________
Other_________
payment to review application within 5
GF#:
____________________
__________________
working days from date received.
BLOCK 2(a): Home Information (required)
Manufacturer Name:
Model:
Address:
Date of Manufacture:
City, State, Zip:
Total Square Feet:
License Number:
Wind Zone:
* NOTE: Size must be
Label/Seal Number
Complete Serial Number
Weight
Size*
reported as the outside
dimensions (length and
Section 1:
X
width) of the home as
measured to the nearest
Section 2:
X
½ foot at the base of the
home, exclusive of the
Section 3:
X
tongue or other towing
device.
Section 4:
X
Is home being sold?
No
Yes
f there is/are no HUD Label(s) or Texas Seal(s) on your home, a Texas Seal will need to be purchased and will
If yes, and i
2(b)
be issued to each section of your home at an additional cost of $35.00 per section.
Indicate which section(s) needs a Texas Seal(s): _________________________ (Single - $35 Double - $70 Triple - $105)
BLOCK 3: Home Location (required)
Physical Location
of Home:
Physical Address (cannot be a Rt. or P. O. Box)
City
State
ZIP
County
(or 911 address)
Was home moved for this sale?
No
Yes If yes, include a copy of moving permit.
Was Home Installed for this sale?
No
Yes If yes, provide installer information below, if known
Installer Name, address and phone:
BLOCK 4: Ownership Information (required)
4(a) Seller(s) or Transferor(s)
4(b) Purchaser(s), Transferee(s), or Owner(s)
Name
License #
Name
License #
if Retailer:
if Retailer:
Name
Name
Mailing Address
Mailing Address
City/State/Zip
City/State/Zip
Daytime Phone Number
Daytime Phone Number
(
)
-
(
)
-
4(c)
Date of sale, transfer or ownership change:
Did the buyer trade-in a home to purchase this home?
No
Yes If yes, the application transferring the ownership to the Retailer
must be attached to this application. Provide the following information on the home traded in:
4(d)
HUD Label ______________________________, Serial No. ______________________________________________
MHD FORM 1023 / APPL_SOL.DOC
Page 1 of 2
Rev. 07/03/2011

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