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

Attach this schedule to your Oregon return Moved out of the mobile home park along with all household members because of the park closure notice Occupied your mobile home as your principal residence; Owned your mobile home; Received a notice that the park was closing while you owned and occupied the mobile home; and Rented space in the closing park for your mobile home; (checkbox) Unchecked (checkbox) Unchecked (checkbox) Unchecked (checkbox) Unchecked (Clear Form) Clear Form (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) 1 Maximum credit amount 1 150 101 178 (Rev 09 14) 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 40 40N or 40P 5 Address of your mobile home at closing park (include city state and ZIP code) Copy of the written notice that you received telling you that the park is closing and the closing date 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 First name and initial For tax year From To 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 Last name Lease agreement with the closing park showing the address where you lived in that park and listing you as the List the name(s) and Social Security number(s) of all owners of your mobile home: Manager s name and phone number Members of your household include you your spouse or registered domestic partner (unless you lived apart the entire mm dd yyyy mm dd yyyy Mobile Home Park Closure 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? occupant Proof of ownership of the mobile or manufactured home Proof that you moved out of the mobile home park Schedule Social Security number (SSN) Spouse s/RDP s first name and initial Spouse s/RDP s last name if married or registered (even if filing separate returns) Spouse s/RDP s Social Security number To qualify you must have: www oregon gov/dor or contact us at 503 378 4988 (or toll free from an Oregon prefix at 1 800 356 4222) 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 Don t 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