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STATE OF ARIZONA
REPORT FOR
MANUFACTURED HOUSING, MOBILE HOME AND MOBILE OFFICE
Dealer Name and License Number
MONTH AND YEAR ________________
ACQUISITION AND SALES REPORT
(SEE INSTRUCTIONS PAGE)
Mailing Address
Page ________ of _________
PREVIOUS OWNER AND LOCATION
CO.
NEW OWNER AND LOCATION
CO.
RE-
RES.
SGL.
COMPLETE SERIAL NUMBER
LIST PRICE
(WHERE UNIT WAS LOCATED)
NO.
(WHERE UNIT CAN BE INSPECTED)
NO.
LOC
OR
OR
MANUFACTURER
(ON TITLE)
(ON TITLE)
OFF.
DBL.
MODEL NAME
MODEL YEAR
SIZE
SELLING PRICE
(Y / N)
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
SER. #
$
YR ________
______ X ______
$
SER. #
$
YR ________
______X ______
$
SER. #
$
YR ________
______ X ______
$
SER. #
$
YR ________
______ X ______
$
SER. #
$
YR ________
______ X ______
$
SER. #
$
YR ________
______ X ______
$
SER. #
$
YR ________
______ X ______
$
Pursuant to A.R.S. § 41-2187, Reports by dealers or brokers to the department of revenue and county assessor. “Every dealer or broker,
as defined in A.R.S. § 41-2142, who acquires or sells a previously titled manufactured home or mobile home, [or park model] as defined in
A.R.S. § 42-19151, shall submit a written report of all such acquisitions and sales to the department of revenue, [Property Tax Division]
and to the county assessor of the county where such dealer or broker is located. Such report shall be submitted by the fifteenth day of each
month for the period of the previous calendar month...”
_________________________________________
Prepared By (Print)
Electronic copies of this form are available at:
Completed forms must be sent by the 15th of the following month to: Arizona Department of Revenue, Personal Property Unit, Room 820,
________________________________________
1600 W. Monroe, Phoenix, AZ 85007, FAX (602) 542-4425.
Preparer’s Phone Number
Send a copy to your local County Assessor (See back for addresses and FAX numbers).
DOR 82525 (Rev. 04/2011)
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