Do I Have a Valid Claim?

Please describe in the space below the problems you are having with your park management:

Have you experienced any of the following sewage problems in the last 4 years? Leave blank if not.

Toilet(s) overflow from backups in the park's sewer lines

Daily

Once a week

A few times a week

Once a month

A few times a month

Once a year

A few times a year

Other

If other, please explain: Raw sewage spills into tub from a backup in the park's sewer lines

Daily

Once a week

A few times a week

Once a month

A few times a month

Once a year

A few times a year

Other

If other, please explain: Sewer odors come into home when a window is open

Daily

Once a week

A few times a week

Once a month

A few times a month

Once a year

A few times a year

Other

If other, please explain: Raw sewage spills occur from outside sewer pipe onto my lot

Daily

Once a week

A few times a week

Once a month

A few times a month

Once a year

A few times a year

Other

If other, please explain: Raw sewage spills running down streets or common areas

Daily

Once a week

A few times a week

Once a month

A few times a month

Once a year

A few times a year

Other

If other, please explain: Smell of sewage in the Park

Daily

Once a week

A few times a week

Once a month

A few times a month

Once a year

A few times a year

Other

If other, please explaink: If you have observed broken sewer pipes, where? Has your property or home been damaged from sewage problems? If so, please describe them below.

Have you experienced problems with the Park's water system in the last 4 years?

Yes

No

My tap water has:

bad odor

bad taste

particles

I purchase bottled water for drinking

I receive low water pressure

constantly

usually in the morning

usually in the evening

I receive rusty or dirty water

Constantly

Other

I believe that I have been overcharged for water

Yes

No

If yes, why? Bacterial contamination of water

Yes

No

If yes, please describe: Other contamination of water

Yes

No

If yes, please describe: If you checked ANY water problems, please describe the problem in detail:

Have you experienced any electrical problems in the last 4 years? If not, please leave blank.

Blackouts

Daily

Once a week

A few times a week

Once a month

A few times a month

Once a year

A few times a year

Other

If other, please explain: Brownouts

Daily

Once a week

A few times a week

Once a month

A few times a month

Once a year

A few times a year

Other

If other, please explain: Power surges

Daily

Once a week

A few times a week

Once a month

A few times a month

Once a year

A few times a year

Other

If other, please explain: Can't run multiple appliances at one time. If so, please provide an example. Loss of frozen/refrigerated food due to loss of power

Yes

No

Breakers trip off

Daily

Once a week

A few times a week

Once a month

A few times a month

Once a year

A few times a year

Other

If other, please explain: Appliance damage or loss:

Yes

No

If yes, please list the items: I have observed exposed wires in the Park

Yes

No

If so, where?: I have had the following problems with my meter: I have had the following problems with my meter: I believe that I have been overcharged for electricity:

Yes

No

If yes, why?: If you have had ANY additional electrical problems, please describe the problems in detail:

Have you experienced any problems with rainwater drainage in the last 4 years? Check all that apply.

When it rains, or after rainfall, water stays on my space

During rainfall, or use of sprinklers, water from other spaces or the street comes onto my space

Rainwater or irrigation water goes under my home

Street drains do not drain properly

Poor drainage has caused damage to my home or skirting or property

There are sinking areas on my space

My home is un-level

My home is sinking

If you have any drainage problems, please describe the problems in detail:

In the last 4 years, check which ones have affected you or that you have personally observed:

Streets/Roads

Potholes

Cracks

Bumps

Depressions (sinking)

Swimming Pool

is not maintained

I would use the pool if it were open

I stopped using the pool

We never had a pool

If you stopped using the pool, why? The park shower(s)

are not maintained

are filthy

are broken

were closed

we never had park showers

If the park showers were closed, when? The park restroom(s)

are not maintained

are filthy

are broken

were closed

do not stock soap, paper towels, or toilet paper for residents

we never had park showers

If the park restrooms were closed, when? The jacuzzi(s) or hot tub(s)

water is cold

is filthy

the thermometer is not working

we never had a jacuzzi

The clubhouse(s)

are not maintained

are filthy

has no furniture

were closed

we never had a clubhouse

If the clubhouse was closed, when? The laundry facility

doesn't have enough machines

is closed

is dirty

machines work poorly

I would use if it were open

we never had laundry facilities

The carwash area(s)

are not maintained

are closed

you have to furnish own hose

we never had one

If the carwash was closed, when? The storage area(s)

are not maintained

are not available to residents

we never had one

The basketball court(s)

are not maintained

weeds in pavement

are not available to residents

we never had one

The tennis court(s)

are not maintained

have no nets

are not available to residents

we never had one

The shuffleboard area(s)

are not maintained

are broken

are not available to residents

we never had one

The barbeque area(s)

are not maintained

have dangerous or broken equipment

we never had one

Hillsides and slopes:

are not maintained/eroding

none/no problems

Trash area:

does not have enough containers

trash often overflows

I can smell the trash area from my home

The fences/gates or perimeter fence

in disrepair

broken, falling down or crumbling

not maintained

no gates/fences

Tress/landscaping

not trimmed

branches touch power lines

grass overgrown

weeds not cut

roots have damaged my driveway/hallway

roots have damaged my mobile home

I am/we are responsible

My driveway:

needs repair or resurfacing

is a dirt surface

I repaired it myself

If you repaired your own driveway, when? Vacant, empty homes:

are an eyesore

are not maintained

vacant homes are left in park for a long time

Lighting in streets/common areas:

is inadequate

poles in disrepair

long delays to replace bulbs/repair lights

Gas lines:

are not maintained

my gas meter is not properly supported

we use propane

I have/had a gas leak

Have you been the victim of vandalism or theft?

Yes

No

If so, when? Graffiti is not removed for long periods of time:

Yes

No

I am aware of drug activity in the park:

Yes

No

I have personal knowledge of the park being cited by governmental agency:

Yes

No

If yes, which agency If you have experienced additional problems with the Park's common areas please describe them in detail.

Have any problems or conditions in the park caused you any emotional distress like the feelings described below?

worry

Fear

Anxiety

Stomachaches

Anger

Shock

Indignity

Nervousness

Loss of weight

Frustration

Depression

Loss of appetite

Sleeplessness

Headaches

Humiliation

Shame

Disappointment

Upset

What kinds of conditions or problems in the Park have caused you to experience these feelings?

Have you or your family experienced any illness or injury caused by problems in the park?

Yes

No

If yes, what illness or injury have you experienced? Dates? Are you under a doctor's care for the condition?

Yes

No

If yes, what are you being treated for? Have you lost time from work because of illness, injury or emotional distress caused by problems in the park?

Yes

No

If yes, why?

Year Model/Manufacturer Purchase price Purchase Year From whom did you purchase your home?

I purchased my home from the park owner of manager

I purchased my home from an independent seller/agent

Has the park interfered with the sale of your home?

Yes

No

If you have attempted to sell your home, please describe all difficulties you have experienced: Have you sold your home?

Yes

No

If yes, what was the selling price? What was the date of sale? How long did you have your home for sale before it sold? Did any potential buyers walk away due to park conditions?

Yes

No

If yes, please explain:

Management/park workers have come onto my space without advance notice:

Yes

No

Park rules are:

selectively enforced

not followed by management

not enforced at all

I have had difficulty communicating with the manager/owenr:

Yes

No

Please describe what action or response, if any is taken by the Park manger/owner when you report any problems or concerns. I have been harassed by the manager/owner:

Yes

No

If yes, please explain:

Have conditions in the Park caused any damage to your home or personal property in the last 4 years? (Example: damage due to sewage backups/spills, damage to appliances, damage to cars, loss of food, clothes ruined, un-leveling of home, etc.)

Yes

No

If so, what types of damage? How was the damage caused? When did the damage occur?

Please list the most recent rent increases you have had:

Date? Rent increased to: Date? Rent increased to: Date? Rent increased to:

Please list the date and rent you were paying before large increases started:

Date? Rent increased to: Please describe any actions the owner/management have taken to make you move out of the park or take away your home. Please describe any actions the owner/manager has taken to interfere with your right to sell your home: Have you discussed selling your home with the owner or manager of the park within the past 4 years if so, what did they tell you? Please explain in detail how have you been harmed by the owner/manager's actions:

Do you have any photographs or videos of park problems? File File File File File File