Required fields are marked with asterisks (*)

Declaration of Site Built and Manufactured Home Ownership

I/we, the undersigned, do hereby declare that I/we are the registered Owner(s) of the home located at,

Property address

Owner Information

Name of Property Owner #1

Mailing address (if different from service address)

Contact phone number

Email address

By submitting this application/form you acknowledge and agree that any electronic signature provided by you herein is the same as a handwritten signature for the purposes of legality, validity, enforceability, and admissibility.

Signature

Clear

Date signed

Name of Property Owner #2

Mailing address (if different from service address)

Contact phone number

Email address 2

Home information (required for site built, and manufactured home)

Purchase price

Purchase date

Lot rental

Does your lot rent include:

Power

Water

Gas

Other

Manufactured Home information

Serial number

Model

Year

Manufacturer

Signature

Clear

Date signed

Stay up to date.

Subscribe to eNotifications to stay connected with City of Medicine Hat news, activities, events, programs, operations and more.