Owner Name

Email Address

PHONE

Community Name

Community Address: City, State, Zip

Age of Community

#of Licensed Sites | Occupied Sites | Vacant Sites

Total Acreage

Community Type Community Type All Age 55+ Senior

Monthly Site Rent $ ______________

Utilities Included in the Site Rent Utilities Included in the Site Rent Water Sewer Trash Cable Electric Natural Gas Other

Utility Infrastructure Utility Infrastructure City Water Private Water System Water Lines Privately Owned Water Lines Dedicated to City / County

Gas Type Gas Type Propane Natural Gas

Sewer System Type Sewer System Type Private Sewage System Sewer Lines Privately Owned Sewer Lines Dedicated to City / County Sewage Treatment Plant / Facility Septic Lagoon Constructed Wetland Other

Road Type Road Type Privately Owned Dedicated to City / County Asphalt Concrete Gravel Dirt Other

Is the Community under Rent Control? Is the Community under Rent Control? Yes No

Average Age of Homes in Community?

Average Lot Size

Is the property in a Flood Zone? Is the property in a Flood Zone? Yes No

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