Form Hcd 475.5 - Power Of Attorney Form - Department Of Housing And Community Development
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1STATE OF CALIFORNIA
BUSINESS, CONSUMER SERVICES AND HOUSING AGENCY
DEPARTMENT OF HOUSING AND COMMUNITY DEVELOPMENT
DIVISION OF CODES AND STANDARDS
REGISTRATION AND TITLING PROGRAM
POWER OF ATTORNEY
SECTION I.
DESCRIPTION OF UNIT
This unit is a:
Manufactured Home/Mobilehome
Commercial Modular
Floating Home
Truck Camper
The Decal (License) No.(s) of the unit is:
The Trade Name of the unit is:
The Serial No.(s) of the unit is:
SECTION II.
APPOINTMENT OF ATTORNEY-IN-FACT
To the Department of Housing and Community Development, and to whom it may concern:
(PRINT FULL NAME)
I,
Last
First
Middle
I,
Last
First
Middle
I,
Last
First
Middle
the undersigned do hereby duly appoint the following named person:
to act as my attorney-in-fact, only to sign papers and documents that may be necessary in order
to secure California registration of or to transfer my interest in the above described unit.
SECTION III.
ASSIGNOR'S CERTIFICATION
I/We agree to guarantee and save harmless the State of California and the Director of
Housing and Community Development from all responsibility which might accrue from the
issuance of California registration or transfer of such unit.
NOTE:
An attorney-in-fact cannot make an affidavit or certificate of the truth of facts
unknown to him.
Signature
Date
Signature
Date
Signature
Date
HCD 475.4 (Rev. 11/14)
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