Mobile Home_Holland o-%-- CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
,.��,:r•, STANDARD/SUPPLEMENTAL DEDUCTION FORM
% - State wmSan(R17/1-16) HC10
Resoibed by the Deparlment of lna Gomnveia Face
INSTRUCTIONS:See mere side for firing i stuctd¢
NOTE Telephone,Social Searit(dluers ficense,state de 55ca5an and federal Weralcaffon rumbas am coedergal under/C 6-1.1-12-37. 1pp���►,11
I(lAle) r. . o e certify that I(we)occupied nay( ) !i JLi
place of residence or am(are)buyin the following dessmbed real property wider contract far which a Homestead Property Tax Standard
Deduction is hereby claimed on the date this application is signed, (date of signature). (v,1(�. Q n n 18
tevwru. ❑ Am(are)buying under recorded contract J�JN LI U
O Am(are)entitled to ocaipy as a tenant-stockholder of a cooperative housing corporation.
❑ Have a beneficial brerest in the bust or the right to oc ipy the property under the terms of a qualified personal residpfcceunu3_T
❑ Am(are)the shareholder, partner,or member of the entity that owns the property.
r AUDITOR
• CLAIMANT:5 INFORMATION .`i jJ-`•�--
Nene al darnart(leper cane)
Semi Seerey amibr of d:matt sates(See the dgh) OliveYs Tame I dedraelon 1 Other nether of derma's spouse(lad the rajas) lasting State
(kprmble coy feyp carra spouse data in have a an seas*motet)
S,rt'J7 CONTRACT RECORDED
noting coca:ma Fee Saple owners ram
Reaados once ware contra S remind Raced reenter Page•- - _ PROPERTY DESCRIPTION. - -- L'.
Canty Towne* Taxing t(a}y,/ Mendip)
I'/I!tquaCCI&Y
Parcel mar tags deaUgem 9 I is the Property n quest=
•• 7/ T / / o ❑Real property '11:9xas�ry'massed=tie Mn(/C 6.l.1-71
If am port=alts reddened aurae rev bed it eaeaQng one(1)ace mat ienedatey suamuWa that studies laed m pond ce nmme,derate me tee and Paton
den properly tamed b ascetics Fine
In14 a S - 6(59 3
__. - PROPERTY�OVJNED ElSE:YHEREBYCL'plffA\T`+' 'P'_i` .ut" 't` slS"-
Sze.Cary,and Tranship Is daimant vacating a homestead?
❑ Yes ❑ No
Sigalre a daFme+ hr , ' j
I hereby certify the above statements are true,correct,and complete. 5.c.-
''(./,)
Address et costa(ramterard meet rite dap�b,at Z/Pma) Address or sacamd easy(ut6erat shed.alp,a bb-eldZO oale)
N/ COO t,) (carnet.(`
• ASSESSOR USE ONLY . 1 ASSESSED VALUE'.. . f'i. HOMESTEAD VALUE.-.1 VALUE NTIALF'�:7
Lind not exceeding one(1)ecre
surer undthg residental bo b proremen Immediately
te1
Other land (2) ;j/fi-1,RV:10-722g7a;
Total land(line 1 plus fine 2) (3)
Residential hnprovetnems or Dweding (4) a, "?yS-
annually assessed motile
manufactured home Carafe (5)
Other improvements (6)
Total improvements(line 4 through fine 6) (7)
Total value(line Spits line 7) (d)
I hereby certify the above is true,coned, Sees tlAasassar Dab egad(nerd;day,yea)
and complete.
Vesting action-Signiae ofAudbr Dab signed(made day,yea)
T �.- r - h---- '<STANDARD DEDUCTION ALLOWANCE R- - r _,-.-,
20 pay 20 Lesser of 60%of the assessed vdue Of the homestead or$65.000.
NoheiThsland g any other provision,the stmt of the deductions prodded in IC 61.1-12 to a mobile home $
that is not assessed as real popes'or to a manufactured home that is not assessed as real property may
not exceed one-hat(114W the assessed value o&te mobile home or ma ufacSUM home.
Sig a Dal caned Iarrxla Oa%pee.)
tffie
Original-Coady Aadaa,File-Stamped Capy-Ter sayer
Regal of 2
•
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• r°. MANUFACTURED (MOBILE) HOME PERMIT OR! I
State Form 7576(R7/4-16)
•� Prescribed by the Department of Local Government Finance
Type of motile home permit:
['Section A-For Moving Section B -Transferring Title (NOTE: Separate permits required if owner intends to both move and transfer title.)
INSTRUCTIONS:
1. A mobile home may not be moved from one location to another unless the owner obtains a permit to move the mobile home from the county treasurer
(IC 6-1.1-7-10)
2. The Bureau of Motor Vehicles may not transfer the title to a mobile home or change names in any manner on the title to a mobile home unless the owner obtains a
permit to transfer the title from the county treasurer.(IC 6-1.1-7-10)
I3. A county treasurer shall issue a permit which is required to either move,or transfer the title to a mobile home if the taxes,special assessments,interest,penalties,
judgments,and costs that are due and payable on the mobile home have been paid. The permit shall state the date it is issued.The treasurer must issue the
permit not later than two(2)business days(excluding weekends and holidays)after the date the treasurer receives a completed permit application.(IC 6-1.1-7-10)
4. A mobile home owner who sells the mobile home to another shall provide the purchaser with the permit required before the sale is consummated. This obligation
does not apply to a mobile home offered for sale at an auction under IC 9-22-1.5 or IC 9-22-1.7.(IC 6-1.1-7-10.4) A person who violates this commits a Class C
infraction.(IC 6-1.1-7-14)
5. A mobile home owner must present a copy of this permit to the Bureau of Motor Vehicles when applying for title transfer. If the mobile home is to be moved,a
separate permit must be requested prior to moving.
6. A Form 7(Notice of Placing of Mobile Home Upon Land or Loft must be filed with the assessor within ten(10)days after the date of placement of the mobile home.
(IC 6-1.1-7-3)
7. The requirement to obtain a permit to move or transfer title to a mobile home does not apply to an abandoned mobile home sold at an auction under IC 9-22-1.5.
NOTE: A permit to move or transfer title to a mobile home expires ninety(90)days after the date the county treasurer issues it.When the permit
expires,it becomes invalid and the owner must obtain a new permit.
ATTENTION: MOVER,HAULER,OR TOWER
A person who is engaged to move a mobile home may not provide that service unless the owner presents him with a permit to move the_ n- ._ile home and
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the permit is dated not more than ninety(90)days before the date of the proposed move.The mover shall retain possession oft • • rr�( Ya, - obile
home is in transit.The mover must return the permit to the owner of the mobile home when the move is completed.IC 6-1.1- '44I ` K_ •
SECTION A-MOVING PERMIT
"c:
Name of owner Date of issuan.a •ei(rfr+' a , •-$)y -
` •
Address(number and street,dy,state,and ZIPcode) Date permit ex. t s-24§ 2e);
.: -: roe. f
Make of mobile home VMot/ r 3 ; • • yq,r
Year Dimension Vehicle identTicab �� ��. � • -�' �
...qp..l.••••' -,
Address of present location(number and street,city,state;and ZIP code) Affected parcel number •c-
-
Address of new location(number and street,city,state,and ZIP code).- Contact telephone number
( )
SECTION B-TITLE TRANSFER PERMIT
Na a of owner "" f�� '� \\ Previous owner's telephone number New owner's telephone nu ber
miter /'1�-t�12 t Ji ncJe.l ( ) (61 ) 33S �
Address of owner(number and street,city,state,and ZIP e) Date of issuance of permit(month,day,year)
110.8 6. I,.\-ter 3-I-- r'hce i - J,J y767o (o 25 rig
Address of location of mobile home(number and street,cittyy,state,,and ZIP code) ^T \ 1/ Date peons e�res(ninety(90)days after date of issuance)
Sn (�• l it -K /.�i(' e "7 (prince J ,) 007
Make of ode home Year Dimension Vehicle identification num r
11-H 198 I4- 03,00).
Name of purchaser Affected parcel number
Zcc ry 1144/N1 �2b- 4-2 -0 0?3-tTD
Address of purchaler number and street,city,state,and ZIP coot e)
SOO te3ain E"4i ` tAse -n-. S,J tF7c70
Is purchaser moving is obde home?
❑Yes No
CERTIFICATION OF COUNTY TREASURER
The application to move or transfer title(as indicated above)of above described mobile home has been reviewed with the records in this office and
I hereby certify that all taxes due on the mobile home have been paid.
Signature of County Treasurer County Dates red(month,day,year)
r,. Q ��s� -� —!8
DISTRIBUTION: Original-Owner of Mobile Home,Copy-County Treasurer,Copy-County Assessor or Township Assessor,if any