Manufactured homes Form 4
Termination notice—by mutual agreement
Manufactured Homes (Residential Parks) Act 2003
This form is effective from 20 August 2014

Warning
Before signing this form, seek independent professional advice from a solicitor, community legal service or financial adviser.
It is an offence under the Manufactured Homes (Residential Parks) Act 2003 (the Act) for a park owner or manager to coerce (try to force) or attempt to coerce a home owner to terminate a site agreement. Significant penalties apply.
It is an offence under the Act for a park owner or manager to agree to terminate a site agreement using this form before or on the same day as entering into the site agreement. Significant penalties apply.

A home owner (or home owners) and the park owner/manager complete this form when both parties agree to terminate the site agreement.

Instructions
After this form has been signed by both parties, the home owner/s must give the park owner/manager
vacant possession of the site on or before the agreed date.
Please complete this form in BLOCK letters. Attach extra pages if needed. Give all references to dates as DD/MM/YYYY.
If you need help completing this form, please contact the Department of Housing and Public Works on 13 QGOV (13 74 68).

Part 1—Home owner (to be completed by home owner/s)

Home owner/s
Name/s of home owner/s

Person 1
Preferred title Mr Mrs Ms Miss Other (specify) ...............
First name ...................................... Last name .........................................

Person 2
Preferred title Mr Mrs Ms Miss Other (specify) ...............
First name ...................................... Last name .........................................

Site and park
Park name ..................................................................................................
Site number (if applicable)..............................................................................
Street name within park (if applicable)............................................................
..................................................................................................................
Park address...............................................................................................
..................................................................................................................
Suburb............................................... State            Postcode

Part 1—Home owner (to be completed by home owner/s) continued

Signature/s of home owner/s

Note: The person witnessing the signature/s must not be an associate or relative of the park owner/manager.

I/We agree to terminate the site agreement to be effective at midnight on / / (date)
Date of this notice / /

Signature 1 ................................................................................................
Name (please print)........................................................................................
Date signed / /

Signature 2 ................................................................................................
Name (please print)........................................................................................
Date signed / /

Signature of witness ...................................................................................
Name (please print)........................................................................................
Date signed / /

Part 2—Park owner/manager (to be completed by park owner/manager)

Park owner/manager
Name of park owner/manager .....................................................................

Signature of park owner/manager
I/We agree to terminate the site agreement to be effective at midnight on
/ / (date)
Date of this notice / /
Signature ...................................................................................................

Name (please print)........................................................................................
Date signed / /

Further information
If you would like more information, contact the Department of Housing and Public Works on
13 QGOV (13 74 68) or visit our website at www.hpw.qld.gov.au.

Residential Services Unit
The Residential Services Unit regulates the Manufactured Homes (Residential Parks) Act 2003. This includes investigating complaints and alleged breaches of the Acts.

Department of Housing and Public Works
GPO Box 690, Brisbane, QLD 4001
Phone: 07 3008 5824
Email: residentialservices@hpw.qld.gov.au 
Website: www.hpw.qld.gov.au/housing

The Park and Village Information Link (PAVIL)
Specialist service providing free information and legal assistance for residents and prospective residents of retirement villages and manufactured home parks in Queensland.

Caxton Legal Centre Inc.  
1 Manning Street, South Brisbane, QLD 4101
Phone: 07 3214 6333
Email: caxton@caxton.org.au
Website: www.caxton.org.au 

Seniors Legal and Support Services Centres
These centres provide free legal and support services for seniors concerned about elder abuse, mistreatment or financial exploitation.

Caxton Legal Centre Inc.  
1 Manning Street, South Brisbane, QLD 4101
Phone: 07 3214 6333
Email: caxton@caxton.org.au
Website: www.caxton.org.au/sails_slass 
 
Queensland Civil and Administrative Tribunal (QCAT)
This independent decision-making body helps resolve disputes and reviews administrative decisions.

GPO Box 1639, Brisbane, QLD 4001
Phone: 1300 753 228
Email: enquiries@qcat.qld.gov.au
Website: www.qcat.qld.gov.au

Queensland Law Society
Find a solicitor

Law Society House
179 Ann Street, Brisbane, QLD 4000 
Phone: 1300 367 757
Email: info@qls.com.au
Website: www.qls.com.au

Department of Justice and Attorney-General
Dispute Resolution Centres provide a free, confidential and impartial mediation service to the community.

Phone: 07 3006 2518
Toll free: 1800 017 288
Website: www.justice.qld.gov.au