Mhd Form 1023 - Application For Statement Of Ownership And Location Page 2
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1
2HUD Label #:
Serial #:
GF# (for title co.):
BLOCK 5: Right of Survivorship (if no box is checked, joint owners will NOT have right of survivorship)
If joint owners desire right of survivorship, check the applicable box below:
Husband and wife will be the only owners and agree that the ownership of the above described manufactured home shall, from this day forward,
be held jointly and in the event of death, shall pass to the surviving owner.
Joint owners are other than husband and wife, desire right of survivorship, and have attached a completed Affidavit of Fact for Right of
Survivorship or other affidavits as necessary to meet the requirements of §1201.213 of the Standards Act.
BLOCK 6: Personal/Real Property Election - Purchaser(s)/Transferee(s)/Owner(s) check one election type
Personal Property – Applicant elects to treat this home as personal property. All documents affecting title to the home will be filed in
the records of the Department.
Real Property – I (we) elect to treat this home as real property as (one box must be checked):
I (we) own the real property that the home is attached to.
I (we) have a qualifying long-term lease for the land that the home is attached to.
The applicant or their authorized representative is the holder or servicer of the loan.
I (We) understand that the home will not be considered to be real property until a certified copy of the SOL has been filed in the real property records of the county in
which the home is located AND a copy stamped “Filed” has been submitted to the Department.
Legal description for real property is attached (Example: Deed, title policy, or title commitment).
If a title company, list your file or GF #: _____________________________________________________________
Inventory – (FOR RETAILER USE ONLY) Retailer number must be provided in Block 4b if this election is checked.
BLOCK 7: To Designate a Home as Non-Residential (Business Use) or Salvage
Home WILL NOT be used for residential use. Home is designated as:
Business Use (means use other than a residential dwelling, such as storage)
Salvage (means scrapped, dismantled, or which the full insured value has been paid by an insurance company). A salvaged
home may only be sold to or rebuilt by a licensed Retailer (subject to inspection and approval prior to construction).
BLOCK 8(a): Liens – Will there be any liens on the home (other than a tax lien)?
No
Yes If yes, complete the below lien information.
Block 8(b): Lien Information
Date of First Lien:
Date of Second Lien:
Name of First Lienholder:
Name of Second Lienholder:
Mailing Address:
Mailing Address:
City/State/Zip:
City/State/Zip:
Daytime Phone:
Daytime Phone:
BLOCK 9: Special Mailing Instructions
Name:
Company:
IF a copy of an SOL is to be mailed to anyone other than
the owner or lienholder of record (such as a closing
Street Address:
agent), please provide that mailing address here.
City, State, Zip:
Area Code/Phone
BLOCK 10: Signatures Required (Notarization is Optional)
10(a) Signatures of each seller/transferor
10(b) Signatures of each purchaser/transferee or owner
____________________________________________
____________________________________________
Signature of purchaser/transferee or owner
Signature of owner or authorized seller
Sworn and subscribed before me this ____ day of ____________, 20___
Sworn and subscribed before me this ____ day of ____________, 20___
____________________________________________
____________________________________________
Signature of Notary
Signature of Notary
SEAL
SEAL
____________________________________________
____________________________________________
Signature of owner or authorized seller
Signature of purchaser/transferee or owner
Sworn and subscribed before me this ____ day of ____________, 20___
Sworn and subscribed before me this ____ day of ____________, 20___
____________________________________________
____________________________________________
Signature of Notary
Signature of Notary
SEAL
SEAL
10(c) For Lien Assignments Only
____________________________________________________________
____________________________________________________________
Signature of authorized representative for previous lienholder
Signature of authorized representative for new lender
MHD FORM 1023 / APPL_SOL.DOC
Page 2 of 2
Rev. 07/03/2011
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