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ATX

FULL NAME ( FIRST NAME, LAST NAME)
ADDRESS (#, STREET NAME, CITY, STATE, ZIP CODE)
PHONE
DOB (MM/DD/YYYY)
YEAR BUILT OF THE MOBILE HOME (If unknown, leave it blank)
SINGLE, DOUBLE WIDE, TRIPLE WIDE
MOBILE HOME VALUE ($)
WIDTH AND LENGHT OF THE MOBILE HOME (If unknown, leave it blank)
IS THE MOBILE HOME ON A MOBILE HOME PARK? YES / NO
TYPE OF FOUNDATION? (CONCRETE SLAB, PIER AND BEAM, STILTS, OTHER)
EMAIL
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