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Purchase Request Information - Illinois Department Of Public Health - Division Of Environmental Health - Manufactured Home Installation Program

REQUEST FOR MANUFACTURED HOME INSTALLATION

SEALS AND CERTIFICATES

Section 25 of the Manufactured Home Quality Assurance Act requires the licensed manufactured home installer to

pay $50 to the Department for each home installed in Illinois after December 31, 2001. Upon receipt, the Department will

provide the installer with a Manufactured Home Installation Seal and a Manufactured Home Compliance Certificate. The seal

is to be placed on the exterior of the home above the HUD label after the installation and the certificate is to be completed

and submitted to the Department within 30 days after the installation of the home. Also copies are to be provided to the

dealer, the homeowner, and the installer must keep a copy for their records.

Checks shall be made payable to the Illinois Department of Public Health and multiple seals and certificates can be

ordered. This form and the payment should be mailed to:

Illinois Department of Public Health

Division of Environmental Health

Manufactured Home Installation Program

525 W. Jefferson St.

Springfield, IL 62761

The Department is requiring that each seal and certificate be assigned to a licensed manufactured home installer.

When we see a seal on a home, we will be able to trace the unique number on the seal to the specific installer if we have any

questions about the installation. In the case where one crew may block and level the home and another crew installs the

anchors, each which requires a licensed installer on site, the installer responsible for the blocking and leveling shall be

responsible for paying the $50 installation fee.

PURCHASE REQUEST INFORMATION

Enclosed is a check in the amount of __________ dollars for __________ manufactured home seals and certificates.

Please send these to:

These shall be assigned to the following Illinois licensed manufactured home installer who has been assigned the following

ID#:

___________________________________________________

#060-_______________________________

Signature of licensed manufactured home installer:

Date:

Purchase Request Information - Illinois Department Of Public Health - Division Of Environmental Health - Manufactured Home Installation Program