Mobile/Manufactured Home Non-Renewal Form Owner and Property InformationName of Owner(Required) First Last How many Owners of Property(Required)Select OneJust the one Listed234567Name of Other Owner(Required) First Last Name of Other Owner(Required) First Last Name of Other Owner(Required) First Last Name of Other Owner(Required) First Last Name of Other Owner(Required) First Last Name of Other Owner(Required) First Last Is there a Trust?(Required)Select OneYesNoFirst and Last Name of Trust(Required) First Last Address(Required) Street Address City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Is the Mailing Address the same as the Property Address?(Required)Select OneYesNoAddress(Required) Street Address City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Damages and ClaimsANY damage from Hurricane Ian?(Required)Select OneYesNoDid you File a Claim?(Required)Select OneYesNoIs the Claim Open or Closed?(Required)Select OneOpenClosedDid you Experience Flood Damage?(Required)Select OneYesNoHeight of Water (In Feet or Inches)(Required) Is all Flood Damage Repaired?(Required)Select OneYesNoIs There Unrepaired Damage to the Property?(Required)Select OneYesNoWhat Items were Damaged?(Required) Add RemoveWhat Items are Unrepaired?(Required) Add RemoveDid you Hire an Attorney for the Claim?(Required)Select OneYesNoDid you Hire a Public Adjuster?(Required)Select OneYesNoUpgrades or ReplacementsWere any Attached Structures updated, such as Converting a screen room to Vinyl or Glass Windows? (Weather Tight Room, Enclosed Carport, or any other Custom Updates)(Required)Select OneYesNoPlease Specify the Updated Structures(Required) Any Other Updates or Upgrades(Required)Select OneYesNoPlease Specify the Updates or Upgrades(Required) Has your Roof ever been Replaced(Required)Select OneYesNoWhat year was your roof fully REPLACED, not just repaired?(Required) Do you have an Attached Shed? (Under Carport, etc.)(Required)Select OneYesNoDo you have a Detached Shed (In the Back or Side Yard)(Required)Select OneYesNoDo you have a Carport?(Required)Select OneYesNoDo you have a Garage?(Required)Select OneYesNoNumber of Add-on Rooms(Required)Select OneNo Add-on Structures12345678Number of Screen Rooms(Required)Select OneNo Screen Rooms12345678Is there Polybutylene or "Gray" Pipes in any of your Plumbing Lines(Required)Select OneYesNo Click here for a Polybutylene Example and Related InformationHas the Electric Panel ever been Replaced?(Required)Select OneYesNoYear of Electric Panel Replacement(Required) Rental and Other InformationIs the Home ever Occupied by Anyone other than you (Such as a Tenant or Short-Term Rental like AirBnB or VRBO)(Required)Select OneYesNoAbout how many Times a year is the Property Rented to Others(Required)Shortest Rental Period for Property(Required) How Many Months do you Occupy the Home Each Year?(Required)Select One0-3 Months4-8 Months9 or more MonthsDo you have any Animals?(Required)Select OneYesNoWhat kind of Animal?(Required)Select OneDogCatOtherNumber of Dogs(Required)Dog Breed(Required)Select OneAkitaChow ChowDoberman PinscherGerman ShephardPresa CanarioRottweilerStaffordshire Terrier (Pit Bull)Wolf Dog HybridsDog Breed(Required)Select OneAkitaChow ChowDoberman PinscherGerman ShephardPresa CanarioRottweilerStaffordshire Terrier (Pit Bull)Wolf Dog HybridsDog Breed(Required)Select OneAkitaChow ChowDoberman PinscherGerman ShephardPresa CanarioRottweilerStaffordshire Terrier (Pit Bull)Wolf Dog HybridsDog Breed(Required)Select OneAkitaChow ChowDoberman PinscherGerman ShephardPresa CanarioRottweilerStaffordshire Terrier (Pit Bull)Wolf Dog HybridsDog Breed(Required)Select OneAkitaChow ChowDoberman PinscherGerman ShephardPresa CanarioRottweilerStaffordshire Terrier (Pit Bull)Wolf Dog HybridsDog Breed(Required)Select OneAkitaChow ChowDoberman PinscherGerman ShephardPresa CanarioRottweilerStaffordshire Terrier (Pit Bull)Wolf Dog HybridsDo you have any Other Animals?(Required)Select OneYesNoWhat kind of Animal?(Required)Select OneCatOtherNumber of Cats(Required)What Other Animal(s) (Please Specify)(Required) Add RemoveNumber of Cats(Required)Do you have any Other Animals?(Required)Select OneYesNoWhat kind of Animal?(Required)Select OneDogOtherNumber of Dogs(Required)Dog Breed(Required)Select OneAkitaChow ChowDoberman PinscherGerman ShephardPresa CanarioRottweilerStaffordshire Terrier (Pit Bull)Wolf Dog HybridsDog Breed(Required)Select OneAkitaChow ChowDoberman PinscherGerman ShephardPresa CanarioRottweilerStaffordshire Terrier (Pit Bull)Wolf Dog HybridsDog Breed(Required)Select OneAkitaChow ChowDoberman PinscherGerman ShephardPresa CanarioRottweilerStaffordshire Terrier (Pit Bull)Wolf Dog HybridsDog Breed(Required)Select OneAkitaChow ChowDoberman PinscherGerman ShephardPresa CanarioRottweilerStaffordshire Terrier (Pit Bull)Wolf Dog HybridsDog Breed(Required)Select OneAkitaChow ChowDoberman PinscherGerman ShephardPresa CanarioRottweilerStaffordshire Terrier (Pit Bull)Wolf Dog HybridsDog Breed(Required)Select OneAkitaChow ChowDoberman PinscherGerman ShephardPresa CanarioRottweilerStaffordshire Terrier (Pit Bull)Wolf Dog HybridsWhat Other Animal(s) (Please Specify)(Required) Add RemoveWhat Other Animal(s) (Please Specify)(Required) Add RemoveDo you have any Other Animals?(Required)Select OneYesNoWhat kind of Animal?(Required)Select OneDogCatNumber of Dogs(Required)Dog Breed(Required)Select OneAkitaChow ChowDoberman PinscherGerman ShephardPresa CanarioRottweilerStaffordshire Terrier (Pit Bull)Wolf Dog HybridsDog Breed(Required)Select OneAkitaChow ChowDoberman PinscherGerman ShephardPresa CanarioRottweilerStaffordshire Terrier (Pit Bull)Wolf Dog HybridsDog Breed(Required)Select OneAkitaChow ChowDoberman PinscherGerman ShephardPresa CanarioRottweilerStaffordshire Terrier (Pit Bull)Wolf Dog HybridsDog Breed(Required)Select OneAkitaChow ChowDoberman PinscherGerman ShephardPresa CanarioRottweilerStaffordshire Terrier (Pit Bull)Wolf Dog HybridsDog Breed(Required)Select OneAkitaChow ChowDoberman PinscherGerman ShephardPresa CanarioRottweilerStaffordshire Terrier (Pit Bull)Wolf Dog HybridsDog Breed(Required)Select OneAkitaChow ChowDoberman PinscherGerman ShephardPresa CanarioRottweilerStaffordshire Terrier (Pit Bull)Wolf Dog HybridsNumber of Cats(Required)