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2. You do not need to create a Civic Plus sign-in account to complete the form.
6. Parcel Identifier Number*
7. Lot Number*
8. Property Location*
12. Landowner Information
14. Name(s)*
16. Mailing Address*
18. City*
19. State*
    -- Select One --AKALARAZCACOCTDCDEFLGAHIIAIDILINKSKYLAMAMDMEMIMNMOMSMTNCNDNENHNJNMNVNYOHOKORPARISCSDTNTXUTVAVTWAWIWVWY
20. Zip Code*
22. Homeowner Information
24. Name(s)*
26. Mailing Address*
28. City*
29. State*
    -- Select One --AKALARAZCACOCTDCDEFLGAHIIAIDILINKSKYLAMAMDMEMIMNMOMSMTNCNDNENHNJNMNVNYOHOKORPARISCSDTNTXUTVAVTWAWIWVWY
30. Zip Code*
32. Telephone Number*
33. E-mail Address*
37. Manufactured Home Information
39. Date of Occupancy*
    Date of Occupancy
40. Purchase Price*
42. Purchase Date*
    Purchase Date
43. Dimension of Home (Length x Width)*
45. Make of Home*
46. Model of Home*
47. Year of Home*
51. Please Check Off the Following, if Applicable:

    1. Addition
    2. Basement
    3. Finished Basement
    4. Carport
    5. Garage
    6. Other Structures
53. Addition Dimensions (Length x Width)*
55. Basement Dimensions (Length x Width)*
57. Finished Basement Dimensions (Length x Width)*
59. Carport Dimensions (Length x Width)*
61. Garage Dimensions (Length x Width)*
63. Other Structures Dimensions (Length x Width)*
67. Home Information:
69. Number of Bedrooms
70. Number of Bathrooms
71. Total Number of Rooms
73. Heating Source
74. Heating Distribution
75. Water/Sewer
79. A Bill of Sale or Title Must be Attached*
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83. 1. Receive an email copy of this form.
84. Email address

    This field is not part of the form submission.

85. Submit

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