T S A

E X

Comptroller of Public Accounts FORM

50-292 (12-01/2)

REQUEST FOR STATEMENT OF UNPAID TAXES ON MANUFACTURED HOME
County appraisal district / County tax office name: Mailing address: Phone (area code and number): Fax (area code and number): Taxing units where manufactured home is located (if known):

City, state, ZIP Code:

Date of request: ________ / ________ / ________

Step 1: Owner's name and address

Owner's name:

Property account number (optional):

Current mailing address (number and street):

City, state, ZIP code + 4:

Phone (area code and number):

Property description:

Step 2: Describe the property

Make: _________________________________ Model: _____________________________ Year Built: ______

Serial Number or HUD Label Number: ____________________________________________________________

Step 3: Location of manufactured home

Physical address: ____________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________

Step 4: Signature of person requesting statement Step 5: Address to send tax statement Step 6: Fee payment

________________________________________________________ Date: _______________ print here ________________________________________________________
Fax (area code and number): Phone (area code and number):

Current mailing address (number and street)

City, state, ZIP code + 4:

To cover the costs for this request, a fee of $ _________ must be paid for each statement requested. Fee Paid: $ ____________