Form HCD RT476.3 "Statement of Facts - Incorrectly Reported Description" - California

What Is Form HCD RT476.3?

This is a legal form that was released by the California Department of Housing & Community Development - a government authority operating within California. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on July 1, 2016;
  • The latest edition provided by the California Department of Housing & Community Development;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form HCD RT476.3 by clicking the link below or browse more documents and templates provided by the California Department of Housing & Community Development.

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Download Form HCD RT476.3 "Statement of Facts - Incorrectly Reported Description" - California

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STATE OF CALIFORNIA
BUSINESS, CONSUMER SERVICES AND HOUSING AGENCY
DEPARTMENT OF HOUSING AND COMMUNITY DEVELOPMENT
DIVISION OF CODES AND STANDARDS
REGISTRATION AND TITLING PROGRAM
STATEMENT OF FACTS
INCORRECTLY REPORTED DESCRIPTION
SECTION I.
ERRONEOUSLY REPORTED DESCRIPTION OF UNIT
The undersigned hereby certifies that on Report of Sale No.
dated
,
the following unit was erroneously reported:
Decal No.:
Manufacturer Trade Name:
Model Name or No.:
Manufacturer Serial No(s).
SECTION II.
CORRECT DESCRIPTION OF UNIT AND OWNER INFORMATION
Following is the correct description of the unit actually sold to:
Registered Owner:
Legal Owner:
Manufacturer Trade Name:
Model Name or No.:
Date of Manufacture:
Date First Sold New:
Unit
Manufacturer Serial No.
HUD Label or HCD Insignia No.
Length
Width
Weight
SECTION III.
DEALER CERTIFICATION
The undersigned requests that this statement be accepted as authorization to register the unit as
described, and the undersigned further agrees to indemnify and save harmless the Director of the
Department of Housing and Community Development, State of California, and subsequent buyers of said
unit, for any loss they may suffer resulting from registration of or issuance of title covering said unit.
I/We certify under penalty of perjury under the laws of the State of California that the foregoing is true and
correct.
Executed on
at
Date
City
State
Signature of Dealer
Dealer No.
Address
Street Address or P.O. Box
City
State
Zip
HCD RT 476.3 (Rev. 07/16)
STATE OF CALIFORNIA
BUSINESS, CONSUMER SERVICES AND HOUSING AGENCY
DEPARTMENT OF HOUSING AND COMMUNITY DEVELOPMENT
DIVISION OF CODES AND STANDARDS
REGISTRATION AND TITLING PROGRAM
STATEMENT OF FACTS
INCORRECTLY REPORTED DESCRIPTION
SECTION I.
ERRONEOUSLY REPORTED DESCRIPTION OF UNIT
The undersigned hereby certifies that on Report of Sale No.
dated
,
the following unit was erroneously reported:
Decal No.:
Manufacturer Trade Name:
Model Name or No.:
Manufacturer Serial No(s).
SECTION II.
CORRECT DESCRIPTION OF UNIT AND OWNER INFORMATION
Following is the correct description of the unit actually sold to:
Registered Owner:
Legal Owner:
Manufacturer Trade Name:
Model Name or No.:
Date of Manufacture:
Date First Sold New:
Unit
Manufacturer Serial No.
HUD Label or HCD Insignia No.
Length
Width
Weight
SECTION III.
DEALER CERTIFICATION
The undersigned requests that this statement be accepted as authorization to register the unit as
described, and the undersigned further agrees to indemnify and save harmless the Director of the
Department of Housing and Community Development, State of California, and subsequent buyers of said
unit, for any loss they may suffer resulting from registration of or issuance of title covering said unit.
I/We certify under penalty of perjury under the laws of the State of California that the foregoing is true and
correct.
Executed on
at
Date
City
State
Signature of Dealer
Dealer No.
Address
Street Address or P.O. Box
City
State
Zip
HCD RT 476.3 (Rev. 07/16)