Horizon Land Management, LLC Lyon's Creek MHC, LLC Resident Registration Lot Address: ______________________________________________

Date: ____________

Mobile Home Information: Make: _________________ Model: ________________ Year: _______ Color: _____________ VIN #: ____________________ Width: _____ Length: _____ State of Registration: _________ Registered Owner (if not applicant): ________________________________________________ Is there a debt or lien on this home? _________________ Amount of debt or lien: __________ If so, who is the lien holder? _______________________ Phone No: ____________________ Insurance Provider: ______________________________ Contact Name: _________________ Policy Number: _________________________________ Contact Phone No. ______________ Resident Information: Name: _____________________________ DOB: ______________________________ SSN: _______________________________

Additional Resident Information: Name: ______________________________ DOB: ______________________________ SSN: _______________________________

Phone No: __________________________ Cell Phone No: _______________________ Email: ______________________________

Phone No:___________________________ Cell Phone No: _______________________ Email: ______________________________

Make/Model/Year of Car:________________ ____________________________________ State of Registration: ___________________ License Plate No: ______________________

Make/Model/Year of Car: ______________ ___________________________________ State of Registration: __________________ License Plate No: _____________________

Copy of valid driver’s license is required.

Copy of valid driver’s license is required.

Other Vehicle: ________________________ State of Registration: ___________________ License Plate No: ______________________

Other Vehicle: _______________________ State of Registration: __________________ License Plate No: _____________________

Employer: ____________________________ Employer Address: _____________________ _____________________________________ Work Phone No: _______________________

Employer: ___________________________ Employer Address: ____________________ ____________________________________ Work Phone No: _____________________

Emergency Contact: ____________________ Relationship: __________________________ Phone No: ____________________________

Emergency Contact: ___________________ Relationship: ________________________ Phone No:___________________________

(Continue to Back Side)

Have you ever filed bankruptcy? Yes / No When? ______________________________

Have you ever filed bankruptcy? Yes / No When? _____________________________

Have you ever been evicted? Yes / No When? _________ Explain: ____________ _____________________________________

Have you ever been evicted? Yes / No When? __________ Explain: __________ ___________________________________

Have you ever been convicted? Yes / No When? __________ Explain: ____________ _____________________________________

Have you ever been convicted> Yes / No When? __________ Explain: __________ ____________________________________

Have you ever been accused or convicted of a sex offence? Yes / No When? __________ Explain: ____________ _____________________________________

Have you ever been accused or convicted of a sex offence? Yes / No When? __________ Explain: __________ ___________________________________

Additional Occupant Information: A. _______________________ Relationship ____________________ Birth Date ___________ B. _______________________ Relationship ____________________ Birth Date ___________ C. _______________________ Relationship ____________________ Birth Date ___________ D. _______________________ Relationship ____________________ Birth Date ___________ Pet Information: If you have any a cat(s) and/or dog, please fill out the attached pet registration form. I DECLARE THAT THE FOREGOING INFORMATION TO BE TRUE & CORRECT. In order to best serve you and your community, it is very important to us, as Community Owners, to have complete and accurate information on all of our residents. Please complete this resident and pet registration (if applicable) and return to the onsite Community Manager in 30 days. Failure to register all residents and pets with the Community is a violation of Community procedures. Resident: ___________________________ Date: _______________________________

Additional Resident:___________________ Date: _______________________________