Form 4 - Termination Notice By Mutual Agreement Page 2
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4Part 1—Home owner (to be completed by home owner/s) continued
Signature/s of home
I/We agree to terminate the site agreement to be effective at midnight on
owner/s
/
/
(date)
Note: The person
witnessing the
Date of this notice
/
/
signature/s must not
be an associate or
relative of the park
Signature 1 ...............................................................................................
owner/manager.
Name
.......................................................................................
(please print)
Date signed
/
/
Signature 2 ...............................................................................................
Name
.......................................................................................
(please print)
Date signed
/
/
Signature of witness ..................................................................................
Name
.......................................................................................
(please print)
Date signed
/
/
Part 2—Park owner/manager (to be completed by park owner/manager)
Park owner/manager
Name of park owner/manager ....................................................................
Signature of park
I/We agree to terminate the site agreement to be effective at midnight on
owner/manager
/
/
(date)
Date of this notice
/
/
Signature ..................................................................................................
Name
.......................................................................................
(please print)
Date signed
/
/
Manufactured Homes (Residential Parks) Act 2003 • Section 36 • Form 4 • V3 • September 2014
Page 2 of 4
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