Work Completion Form - Washington Department Of Commerce

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Work Completion Form
(Mobile Home Relocation Assistance)
Mobile Homeowner’s Name:
Mobile Home Park/Manufactured HousingCommunity Name (if applicable):
If homeowner paid all moving expenses, please sign and date in this section.
I confirm that my home has been moved and installation is complete. All work done on
my home by the contractor has been completed in a satisfactory manner.
Signature of Mobile Homeowner
Date
Signature of Contractor
Date
If a two party agreement has been signed, please sign and date in this section.
I confirm that my home has been moved and installation is complete. All work done on
my home by the assignee or its’ contractor has been completed in a satisfactory manner.
I give my consent for final payment to be disbursed in accordance with my assignment
(Assignee’s name),
contract with
dated
, which is attached to this document.
Signature of Mobile Homeowner
Date
Signature of Assignee/Contractor
Date
OMH\_Ombuds\RELO\RELO Packet Documents\2010 Updates\work Completion Form
February 2010

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