Fillable APPLICATION FOR STATEMENT OF OWNERSHIP TEXAS DEPARTMENT OF (Texas Secretary of State)

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APPLICATION FOR STATEMENT OF OWNERSHIP TEXAS DEPARTMENT OF (Texas Secretary of State)

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MHD FORM 1023 / Statement of Ownership Appl.doc Page 1 of 2 Rev. 01/16/18
TEXAS DEPARTMENT OF HOUSING AND COMMUNITY AFFAIRS
M
ANUFACTURED HOUSING DIVISION
P. O. BOX 12489 Austin, Texas 78711-2489
(800) 500-7074, (512) 475-2200 FAX (512) 475-1109
Internet Address: www.tdhca.state.tx.us/mh/index.htm
APPLICATION FOR STATEMENT OF OWNERSHIP
The filing of an application for the issuance of a Statement of Ownership 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
Type of Transaction
Type of Handling (Check One)
(For Department Use Only) Coding:
Lien on file: Y / N
Right of Survivorship: Y / N
Texas Seal Purchase: Y / N
For Section(s) 1 2 3 4
Personal Property
Transaction
New
Used
Lien Assignment
Convert back to
Personal Property
Other:__________
____________________
Real Property Transaction
New
Used
Update
Other_________
__________________
Process application in the normal 15
working days.
A payment of $55 per transaction is required
(total amount can be combined into one
payment).
Process application within 5 working
days from receipt.
An additional $55 service fee must be added to
the total payment to have the application
processed within 5 working days from receipt.
BLOCK 2(a): Home Information (required)
Manufacturer Name:
Address:
City, State, Zip:
License Number:
Model:
Date of Manufacture:
Total Square Feet:
Wind Zone:
Sections
Label/Seal Number
Complete Serial Number
Weight
Size*
* NOTE: Size must be
reported as the outside
dimensions (length and
width) of the home as
measured to the nearest ½
foot at the base of the home,
exclusive of the tongue or
other towing device.
Section 1:
X
Section 2:
X
Section 3:
X
Section 4:
X
2(b)
DOES HOME HAVE A HUD LABEL OR TEXAS SEAL? Yes No
If there is/are no HUD Label(s) or Texas Seal(s) on your home, a Texas Seal will need to be purchased and will be issued to each section
of your home at an additional cost of $35.00 per section.
Indicate which section(s) need(s) Texas Seal: Section One Section Two Section Three Section Four
BLOCK 3: Home Location (required)
Physical
Location of
Home:
(or 911 address)
Physical Address (cannot be a Rt. or P. O. Box)
City State ZIP County
Was Home Moved for this sale? Yes
No If yes, include a copy of moving permit.
Was Home Installed for this sale? Yes No 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 #
if Retailer:
Name
License #
if Retailer:
Name
Name
Mailing Address
Mailing Address
City/State/Zip
City/State/Zip
Daytime Phone Number (include area code) Daytime Phone Number (include area code)
4(c)
Is this transaction a sale? Yes No
4(d)
Date of sale, transfer or ownership change:
Check Status & Print
STATUS:
INCOMPLETE
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MHD FORM 1023 / Statement of Ownership Appl.doc Page 2 of 2 Rev. 01/16/18
HUD 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:
Married couple 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 married couple, 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: Election - Purchaser(s)/Transferee(s)/Owner(s) check one election type
All manufactured housing is titled as Personal Property, unless elected as:
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 Statement of Ownership 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.
Please attach a legal description of the real property to this application (Example: Exhibit A, Deed or Title Commitment).
If a title company, list your file or GF #: _____________________________________________________________
Inventory – (FOR RETAILER USE ONLY) Retailer license number must be provided in Block 4b if this election is checked.
BLOCK 7: To Designate a Home as Business Use, Non-Residential, or Salvage
If
home WILL NOT be used for residential use, indicate its designated use:
Business Use (means the use of a manufactured home in conjunction with operating a business, for a purpose other than as a permanent or temporary residential
dwelling)
Purchaser intends for a person to be present in the home for regularly scheduled work shifts of not less than eight hours each day.
Non-Residential Use Other than Business Use or Salvage (means use of a manufactured home for a purpose other than as a permanent or temporary residential
dwelling)
Salvage (For purposes of Chapter 1201 of the Standards Act, a manufactured home is salvaged if the home is scrapped, dismantled, or destroyed or if an insurance
company pays the full insured value of the home.) 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)? Yes No 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
IF a copy of a Statement of Ownership is to be mailed to
anyone other than the owner or lienholder of record (such
as a closing agent), please provide that mailing address
here.
Name:
Company:
Mailing Address:
City, State, Zip:
Area Code/Phone:
Email:
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 owner or authorized seller
Sworn and subscribed before me this ____ day of ____________, 20___
____________________________________________
Signature of Notary
SEAL
____________________________________________
Signature of purchaser/transferee or owner
Sworn and subscribed before me this ____ day of ____________, 20___
____________________________________________
Signature of Notary
SEAL
____________________________________________
Signature of owner or authorized seller
Sworn and subscribed before me this ____ day of ____________, 20___
____________________________________________
Signature of Notary
SEAL
____________________________________________
Signature of purchaser/transferee or owner
Sworn and subscribed before me this ____ day of ____________, 20___
____________________________________________
Signature of Notary
SEAL
10(c) For Lien Assignments Only
____________________________________________________________
Signature of authorized representative for previous lienholder
____________________________________________________________
Signature of authorized representative for new lender
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APPLICATION FOR STATEMENT OF OWNERSHIP TEXAS DEPARTMENT OF (Texas Secretary of State)

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Completed 13 April 2022

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