Mhd Form 1056 – Fill Out and Use This PDF

Texas Department of Housing and Community Affairs

MANUFACTURED 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

RIGHT OF RESCISSION WAIVER

(MUST contain all required information and be signed by all of the consumers entitled to the disclosures and right of rescission)

This form may be used ONLY in a county declared by the governor to be a major disaster area and ONLY under the following circumstances:

•It has been less than one year since the county identified below was declared a major disaster area.

•The undersigned consumer has determined that the purchase of the manufactured home is needed to meet a bona fide personal emergency.

BLOCK 1: Major Disaster Area Declaration Information (Required)

County declared by the governor to be a major disaster area:

Date on which the specified declaration was made:

BLOCK 2: Statement of Facts (Required)

Please provide a written statement in the space below that describes the bona fide personal emergency that necessitates the immediate purchase of the manufactured home.

BLOCK 3: Signatures (Required)

I, the undersigned, do hereby certify that the information provided herein is true and correct and that I have elected to modify or waive the right to rescind and the deadlines for disclosures as follows (check only one box):

WAIVE the right to rescind and the deadlines for disclosures before the execution of the contract that are provided by Occ. Code 1201.164(a).

MODIFY the right to rescind and/or the deadlines for disclosures as follows (each modification MUST be specified):

_______________________________________________________________________________________________________

_______________________________________________________________________________________________________

(Signature)(Signature)

Before me personally appeared the person(s) whose signature(s) appear above, who by being sworn, upon oath,

say that the statements set forth hereinabove are true and correct. Subscribed and sworn before me this						day
of		20		.

(Name of Notary)

SEAL

(Notary Public)

(Commission Expires)

Notary Public State of Texas

MHD FORM 1056 / WAIVER.DOC

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