Form Lq9 - Delaware Manufactured Home Relocation Trust Fund Page 2
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4DELAWARE DIVISION OF REVENUE
Revenue Code 0029-01
MANUFACTURED HOME RELOCATION TRUST FUND - FORM LQ9 0308
A
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B
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A
X
P
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BUSINESS CODE GROUP DESCRIPTION
D
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E
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N
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R
B
E
F
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06/30/13
200 RELOCATFEE
07/22/13
*DF44013029999*
BUSINESS NAME AND MAILING ADDRESS
A
B
C
Total Number
Total Amount Collected
Total Amount
ASSESSMENT BASI S
of Lots Rented
from Tenant
Collected from Owner
. 1
A
P
R
L I
. 1
. 1
. 1
. 2
M
A
Y
. 2
. 2
. 2
COMMUNITY NAME AND LOCATION ADDRESS
. 3
J
U
N
E
. 3
. 3
. 3
4. DELINQUENT PAYMENTS
4.
4.
Community Name
5. TOTAL
5.
5.
(Add Lines 1 thru 4.)
Community Address
TOTAL AMOUNT DUE
$
City
State
Zip Code
(Add Columns B and C).
TAX PARCEL ID NUMBER
X
Mail This Form With Remittance Payable to:
Delaware Division of Revenue
AUTHORIZED SIGNATURE
DATE
I declare under penalties of perjury that this is a true, correct and complete return.
P.O. Box 2340
If desired, provide an E-mail address where we may contact you regarding this return.
Wilmington, DE 19899-2340
TELEPHONE NUMBER
DELAWARE DIVISION OF REVENUE
Revenue Code 0029-01
MANUFACTURED HOME RELOCATION TRUST FUND - FORM LQ9 0308
A
C
C
O
U
N
T
N
U
M
B
E
R
T
A
X
P
E
R
O I
D
E
N
D
N I
G
BUSINESS CODE GROUP DESCRIPTION
D
U
E
O
N
O
R
B
E
F
O
R
E
09/30/13
200 RELOCATFEE
10/21/13
*DF44013039999*
BUSINESS NAME AND MAILING ADDRESS
A
B
C
Total Number
Total Amount Collected
Total Amount
ASSESSMENT BASI S
of Lots Rented
from Tenant
Collected from Owner
. 1
J
U
L
Y
. 1
. 1
. 1
2. AUGUST
2.
2.
2.
COMMUNITY NAME AND LOCATION ADDRESS
3. SEPTEMBER
3.
3.
3.
4. DELINQUENT PAYMENTS
4.
4.
Community Name
5. TOTAL
5.
5.
(Add Lines 1 thru 4.)
Community Address
TOTAL AMOUNT DUE
$
(Add Columns B and C).
City
State
Zip Code
TAX PARCEL ID NUMBER
X
Mail This Form With Remittance Payable to:
Delaware Division of Revenue
DATE
AUTHORIZED SIGNATURE
I declare under penalties of perjury that this is a true, correct and complete return.
P.O. Box 2340
Wilmington, DE 19899-2340
If desired, provide an E-mail address where we may contact you regarding this return.
TELEPHONE NUMBER
DELAWARE DIVISION OF REVENUE
Revenue Code 0029-01
MANUFACTURED HOME RELOCATION TRUST FUND - FORM LQ9 0308
A
C
C
O
U
N
T
N
U
M
B
E
R
T
A
X
P
E
R
O I
D
E
N
D
N I
G
BUSINESS CODE GROUP DESCRIPTION
D
U
E
O
N
O
R
B
E
F
O
R
E
12/31/13
200 RELOCATFEE
01/21/14
*DF44013049999*
BUSINESS NAME AND MAILING ADDRESS
A
B
C
Total Number
Total Amount Collected
Total Amount
ASSESSMENT BASI S
of Lots Rented
from Tenant
Collected from Owner
1. OCTOBER
1.
1.
1.
2. NOVEMBER
2.
2.
2.
COMMUNITY NAME AND LOCATION ADDRESS
3. DECEMBER
3.
3.
3.
4. DELINQUENT PAYMENTS
4.
4.
Community Name
5. TOTAL
5.
5.
(Add Lines 1 thru 4.)
Community Address
TOTAL AMOUNT DUE
$
(Add Columns B and C).
City
State
Zip Code
TAX PARCEL ID NUMBER
X
Mail This Form With Remittance Payable to:
Delaware Division of Revenue
DATE
AUTHORIZED SIGNATURE
I declare under penalties of perjury that this is a true, correct and complete return.
P.O. Box 2340
Wilmington, DE 19899-2340
If desired, provide an E-mail address where we may contact you regarding this return.
TELEPHONE NUMBER
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