Del. Admin. Code tit. 1, 200, 201, app A
DELAWARE MANUFACTURED HOME RELOCATION AUTHORITY
TENANT APPLICATION FOR RELOCATION ASSISTANCE
I hereby request assistance from the Delaware Manufactured Home Relocation Trust Fund as set forth in 25 Del.C. § 7012. By signing this form, I certify that I am a tenant as defined in 25 Del.C. § 7003(u) and that I have paid my share of the total Trust Fund assessment during the course of my tenancy. I understand that it is a class A misdemeanor for a tenant or a tenant's agent to file any notice, statement, or other document required hereunder which is false or contains a material misstatement of fact.
____________________________ _________________
(Signature of Tenant) (Date)
____________________________
(Social Security No.)
TENANTS NAME _____________________________________________________
(Please Print)
PARK NAME ________________________________________________________
UNIT ADDRESS: ______________________________________ ________
Space No.
CITY/STATE/ZIP CODE: _______________________________________________
Mailing Address if different from where unit is:
_______________________________________
_______________________________________
PHONE NUMBER: _______________ SINGLE-WIDE___ DOUBLE-WIDE___
UNIT SIZE: _____ YEAR: ________ MANUFACTURER: __________________
Please attach: (a) a copy of your title or a notarized document showing ownership; (b) a copy of the notice of termination or non-renewal of your rental agreement due to a change in use of land; (c) if you are seeking relocation expenses, you must submit a copy of your contract with a licensed moving or towing contractor for the moving expenses for your home; (d) if you believe that your home is non-relocatable, provide a brief description of the reason for your belief. (If the Authority determines that your home is in fact non-relocatable, you must obtain at your expense, an appraisal prepared by a certified manufactured home appraiser. A list of qualified appraisers may be obtained by contacting the Authority). If you elect to abandon your home, please so note below. Under the Act, the maximum benefit payable to a Tenant who elects to abandon his or her home is $1,500.00 for a single section home and $2,500.00 for a multi-section home.
Type of Benefits Applied For: (Check the Appropriate Benefit and Amount Requested)
A. Relocation Expenses of Moving Home ______ $________________
B. Abandonment Payment ______ $________________
C. Non-Relocatable Home Payment ______ $________________
This form must be completed and returned along with the required documents to:
Delaware Manufactured Home Relocation Authority Dover,
Delaware 19901
Del. Admin. Code tit. 1, 200, 201, app A