Form Schd MPC Fillable Mobile Home Park Closure
(all forms fillable on Windows, Mac, Android tablets, and iPad using Adobe Reader XI)

101 178 Attach this schedule to your Oregon return (checkbox) Unchecked (checkbox) Unchecked (checkbox) Unchecked (checkbox) Unchecked (Clear Form) Clear Form (even (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) 1 800 356 4222) 1 Maximum credit amount 1 2 Enter the amount that was paid to you because the park closed due to eminent domain 2 3 Line 1 minus line 2 3 4 Enter the total credit amount claimed by all other owners of your mobile home 4 5 000 00 5 Your credit: Line 3 minus line 4 Enter this amount on Form 40S 40 40N or 40P 5 503 378 4988 address Address of your mobile home at closing park (include city state and ZIP code) agreement along because closing closing closing closure contact Date the park owner or landlord gave you the park closure notice (mm/dd/yyyy) Date you and all members of your household moved out of mobile home park (mm/dd/yyyy) Dates you occupied your mobile home as principal residence at the closing park filing first First name and initial For tax year From To home; home; household Important documents to keep with your tax records to support your claim: Important: If you claim this credit you must keep the important documents listed below with your tax records for three Important: This credit must be claimed for the year you moved out of the mobile home park For more information visit initial Last name Lease List the name(s) and Social Security number(s) of all owners of your mobile home: listing lived Manager s name and phone number manufactured married members Members of your household include you your spouse or registered domestic partner (unless you lived apart the entire mm dd y yyy mm dd y yyy mobile mobile mobile mobile Mobile Home Park Closure moved Name of closing park Name of other owner(s) SSN of other owner(s) Did they live with you at any time during the year? notice notice number occupant occupied Oregon owned ownership prefix principal Proof received registered Rented residence; returns) Schedule Security separate showing Social Social Security number (SSN) space Spouse s/RDP s Spouse s/RDP s telling To qualify you must have: toll free where while written www oregon gov/DOR year) and anyone else who lived in your home with you during any part of the year years after the year the credit has been claimed Do not send these items unless requested Yes No Yes No You may qualify for this credit if you moved out of a mobile (or manufactured) home park because it closed or was closing