Form Ptr-2b - Mobile Home Owners-Verification Of 2002 Mobile Home Park Site Fees printable pdf download

Form Ptr-2b - Mobile Home Owners-Verification Of 2002 Mobile Home Park Site Fees

Form PTR-2B

Mobile Home Owners

Verification of 2002 Mobile Home Park Site Fees

(see instructions on back)

Part I — To Be Completed By Applicant

(Part II to be completed by mobile home park owner or manager)

–

Social Security Num ber

Spouse’s S ocial Security Num ber

Nam e

Last Nam e, First N am e and Initial (Joint filers enter first nam e a nd initial of each - E nter spo use’s last nam e O NL Y if different)

Address

S tree t

City

S tate

Zip

M obile Hom e Park Site #

A. Did you occupy your m obile hom e with som eone other than your spouse and share site

Yes

fees with them ? If you (and your spouse) were the sole occupant, check “No.”

B. If yes, indicate the share (percentage) of the site fees that you (and your spouse) paid.

If you (and your spouse) were the sole occupant, enter 100% .

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

2002 Site Fees

1. Total site fees due under agreement

with mobile home park ........................... $

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

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 amount of site fees due and paid for calendar year

2002 are true and accurate to the best of my knowledge.

__________________________________________

(Name)

__________________________________________

(Title)

(Phone)

Part III — To Be Completed By Applicant

3. Total number of residents (including applicant)

who shared site fees. (Spouses filing joint

application count as one (1) occupant) ...........

4. Total site fees paid by all residents living at this address. (Enter

amount from Part II, Line 2)........................................................... $

5. Share (percentage) of site fees that you (and your spouse) paid

from Part I, Line B. (Enter this number as a decimal. For

example, if the share is 50%, enter 0.50. If you were the sole

occupant, enter 1.00) ....................................................................

6. Total site fees paid by you (and your spouse)

(Line 4 × Line 5)............................................................................ $

Enter in space for site fees at Line 10, Form PTR-2

(If you complete this form, be sure to enclose it with your Form PTR-2 application)

Form Ptr-2b - Mobile Home Owners-Verification Of 2002 Mobile Home Park Site Fees

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