Looking for a Nj Tax Forms And Templates? Download it for free!

Form PTR-1B

Mobile Home Owners

Verification of 2015 and 2016 Mobile Home Park Site Fees

(Applicant completes Parts I and III. Mobile home park owner or manager completes Part II.

Use blue or black ink. See instructions for completion on back.)

Part I — To Be Completed by Applicant

Social Security #

–

Spouse’s/CU Partner’s Social Security #

–

Name

________________________________________________________________________________________

Last name, First Name, and Initial (Joint filers, enter first name and initial of each - Enter spouse’s/CU partner’s name ONLY if different)

Address ________________________________________________________________________________________

Street

City

State

Zip Code

2015

2016

Mobile Home Park Site # __________________________________

A. Did someone who was not your spouse/CU partner occupy your mobile

Yes

home and share site fees with you? If you (and your spouse/CU partner)

were the sole occupant(s), check “No.”

B. Indicate the share (percentage) of the site fees that you and your

spouse/CU partner paid. If you (and your spouse/CU partner)

were the sole occupant(s), enter 100%.

Part II — To Be Completed by Mobile Home Park Owner or Manager

Column A — 2015 Site Fees

Column B — 2016 Site Fees

(Do not include municipal service fees or other charges)

1. Total site fees due for calendar year 2015

1. Total site fees due for calendar year 2016

under agreement with mobile home park . . . .$ _______

2. Total site fees paid by resident(s) for

calendar year 2015 only . . . . . . . . . . . . . . . . .$ _______

calendar year 2016 only . . . . . . . . . . . . . . . . .$ _______

If Line 2 is less than Line 1, do not complete the

certification. The applicant is not eligible for a

reimbursement.

Under the penalties of perjury, I certify that I am the owner or manager of____________________________________,

where the above mobile home site is located. I further certify that the above-stated amounts of site fees due were paid

for calendar years 2015 and 2016 and are true and accurate to the best of my knowledge.

_____________________________________________________________________________________________

(Name)

(Title)

(Date)

(Phone)

Part III — To Be Completed by Applicant

(AFTER Part II has been completed by mobile home park owner or manager)

Column A — 2015

Column B — 2016

3. Total site fees paid by all residents living at this

address. (Enter amount from Part II, Line 2,

Column A). . . . . . . . . . . . . . . . . . . . . . . . . . . . $ _______

Column B) . . . . . . . . . . . . . . . . . . . . . . . . . . . $ _______

4. Share (percentage) of site fees that you (and

your spouse/CU partner) paid in 2016. (Enter

your spouse/CU partner) paid in 2015. (Enter

percentage from Part I, Line B as a decimal.

For example, if the share is 50%, enter 0.50.

If 100%, enter 1.00) . . . . . . . . . . . . . . . . . . . . ×_______

5. Total site fees paid by you (and your spouse/

CU partner) (Line 3 × Line 4) . . . . . . . . . . . . . $ _______

6. Total property taxes paid by you (and your

spouse/CU partner) (Line 5 × 0.18). Enter

this amount on Line 14, Form PTR-1 . . . . . $ _______

this amount on Line 13, Form PTR-1 . . . . . $ _______

(If you complete this form, be sure to enclose it with your Form PTR-1 application.)

Form Ptr-1b - Mobile Home Owners Verification Of Mobile Home Park Site Fees - 2015-2016

Related Articles

Related forms

Related Categories