T S A
E X
Comptroller of Public Accounts FORM
50-292 (12-01/2)
REQUEST FOR STATEMENT OF UNPAID TAXES ON MANUFACTURED HOME
County appraisal district / County tax office name: Mailing address: Phone (area code and number): Fax (area code and number): Taxing units where manufactured home is located (if known):
City, state, ZIP Code:
Date of request: ________ / ________ / ________
Step 1: Owner's name and address
Owner's name:
Property account number (optional):
Current mailing address (number and street):
City, state, ZIP code + 4:
Phone (area code and number):
Property description:
Step 2: Describe the property
Make: _________________________________ Model: _____________________________ Year Built: ______
Serial Number or HUD Label Number: ____________________________________________________________
Step 3: Location of manufactured home
Physical address: ____________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________
Step 4: Signature of person requesting statement Step 5: Address to send tax statement Step 6: Fee payment
________________________________________________________ Date: _______________ print here ________________________________________________________
Fax (area code and number): Phone (area code and number):
Current mailing address (number and street)
City, state, ZIP code + 4:
To cover the costs for this request, a fee of $ _________ must be paid for each statement requested. Fee Paid: $ ____________