Manufactured Home Information

A 216 (R2022-11)
ISC: Confidential

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Serial Number

Check Applicable Change Box [required]

Ownership Change

Ownership Addition/Removal

New Home

Vacant

Demolished

To be completed by owner or occupant of manufactured home

Manufactured Home Park

Lot Number

Name of Owner/Occupant [required]

Phone [required]

Alternate Phone

Name of Other Owner/Occupant

Phone

Alternate Phone

Mailing Address

Email Address

Re-enter Email Address

These two Emails must match.

Check Applicable Occupant Type Box [required]

Rent

Own

Rent to Own

Name and Mailing Address of Owner (if different from above)

Name of Park Manager

Phone

Move In Date

Make of Unit

Year of Construction

Colour

Length

Width

Addition (Dimensions) Length

Width

Number of Bedrooms

Number of Bathrooms

Fireplaces

Yes

Air Conditioning

Yes

Parking Type

Garage

Carport

None

If Garage / Carport

Length in feet

Width in feet

Year of Construction

Move Out Date

Multiple Listing Service (MLS) Sale?

Yes

Comment

Forwarding Address

Purchase Price

Purchase Date

Authorizing Name

By filling this field with your name you confirm that the information provided is accurate to the best of your knowledge

Signature Date

This information is collected under authority of both the Municipal Government Act (MGA) section 295(1), and the Freedom of Information and Protection of Privacy Act, (FOIP) section 33(c). The information will be used by The City of Calgary to develop market value assessments for manufactured homes. Any personal information provided will be handled by The City of Calgary in accordance with the privacy provisions of FOIP. Should you have questions regarding the collection, use or disclosure of this information, please contact Assessment's FOIP Program Administrator at 403-268-4430.

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