Get CA HCD-OL-419 2001-2024

REQUEST FOR ASSISTANCE --Mobilehome Park Complaint-STATE OF CALIFORNIA Business Transportation and Housing Agency DEPARTMENT OF HOUSING AND COMMUNITY DEVELOPMENT OFFICE OF THE MOBILEHOME OMBUDSMAN P. Box 31 Sacramento CA 95812-0031 Toll Free 1-800-952-5275 or Local 916 323-9801 From TDD Phones 1-800- 735-2929 From Voice Phones 1-800- 735-2922 HCD Web Site www. REQUEST FOR ASSISTANCE --Mobilehome Park Complaint-STATE OF CALIFORNIA Business Transportation and Housing Agency DEPARTMENT OF HOUSING AND COMMUNITY DEVELOPMENT OFFICE OF THE MOBILEHOME OMBUDSMAN P. Box 31 Sacramento CA 95812-0031 Toll Free 1-800-952-5275 or Local 916 323-9801 From TDD Phones 1-800- 735-2929 From Voice Phones 1-800- 735-2922 HCD Web Site www. hcd. ca*gov For Official Use Only Code SECTION 1 - GENERAL INFORMATION NAME Date Last First M. I. MAILING ADDRESS P. Box or Number and Street PHYSICAL LOCATION OF HOME If different from your mailing address TELEPHONE NUMBERS Home Number and Street City County Work Zip State MOBILEHOME PARK NAME PARK MANAGER/OWNER S NAME TELEPHONE SECTION 2 - BRIEF DESCRIPTION OF THE COMPLAINT S AS IT/THEY RELATE S TO PARK OPERATION or MAINTENANCE ALTERATIONS ACCESSORY STRUCTURES or THE MOBILEHOME RESIDENCY LA W* Please attach copies of documents letters pictures etc* that demonstrates the nature of the Mobilehome Park complaint s. HCD-OL-419 Revised 12-01 Continued On Reverse Side SECTION 2 Continued Attach Additional Sheets If Necessary SECTION 3 - CERTIFICATION AND SIGNATURE I certify that the information given in this request and any attachments hereto is true and correct to the best of my knowledge and that I will testify to these facts if requested to do so in any action brought by the Department of Housing and Community Development Department against any mobilehome park owner or operator or any person or persons found by this Department to be in violation of either laws or regulations during any investigation resulting from this request for assistance. I understand that copies of this request may be given to other agencies responsible for resolution of the complaint s identified herein and that copies may be given to the mobilehome park owner or operator. SIGNATURE SIGNED IN THE CITY OF DATE COUNTY STATE ANONYMITY REQUEST I request that this Department in its investigations not reveal my name or identity to my mobilehome park owner or operator. Box 31 Sacramento CA 95812-0031 Toll Free 1-800-952-5275 or Local 916 323-9801 From TDD Phones 1-800- 735-2929 From Voice Phones 1-800- 735-2922 HCD Web Site www. hcd. ca*gov For Official Use Only Code SECTION 1 - GENERAL INFORMATION NAME Date Last First M. I. MAILING ADDRESS P. hcd. ca*gov For Official Use Only Code SECTION 1 - GENERAL INFORMATION NAME Date Last First M. I. MAILING ADDRESS P. Box or Number and Street PHYSICAL LOCATION OF HOME If different from your mailing address TELEPHONE NUMBERS Home Number and Street City County Work Zip State MOBILEHOME PARK NAME PARK MANAGER/OWNER S NAME TELEPHONE SECTION 2 - BRIEF DESCRIPTION OF THE COMPLAINT S AS IT/THEY RELATE S TO PARK OPERATION or MAINTENANCE ALTERATIONS ACCESSORY STRUCTURES or THE MOBILEHOME RESIDENCY LA W* Please attach copies of documents letters pictures etc* that demonstrates the nature of the Mobilehome Park complaint s. .