Mobile Home Reporting Form Part 2

Space Rental Information

1. Space Number:

2. Type of unit currently occupying space:

3. Move in date of current unit occupying space:

4. Monthly space rent as of 12/31/2015:

5. Did the monthly space rent change at any time in 2015? (Attach additional pages if it changed more than once in 2015.)

Yes

a. If yes, by what amount?

b. If yes, by what effective date?

6. Was any credit, discount, or other reduction applied to the monthly space rent at any time in 2015 such that the space rent was different than the amount in response #4?

Yes

a. If yes, specify the amount of credit, discount or other reduction:

b. If yes, specify the date(s) of credit, discount or other reduction:

c. If yes, describe the type of credit, discount or other reduction and state the reason therefore:

(Attach additional pages if needed or if more than one credit, discount, or other reduction was applied to the monthly Space Rent for this space in 2015.)

Converted Use Spaces

1. Was the mobile home space listed in #1 in the space rental information section converted from use by a mobile home to any other use within 2015?

Yes

(attach additional pages if it changed more than once in 2015)

A. Mobile home space number:

B. Current use:

C. Previous use:

I declare under penalty of perjury under the laws of the State of California that the information contained in this Annual Reporting Form is true and correct.

Date:

Print Name:

Title:

Contact Phone Number:

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