Mobile Home_Stewart .0,-m, CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
a 4ia,1t. STANDARD/SUPPLEMENTAL DEDUCTION HOCRM a
State Form 5473(R18/1-20)
Prescribed by the Department of Local Government Finance
INSTRUCTIONS:See reverse side for filing instructions.
NOTE:Telephone,Social Security,driver's license,state identification and federal identification numbers are confidential under IC 6-1.1-12-37.
CERTIFICATION STATEMENT
I(We) Cs...I CA.d'\se5 "C _6-fete,/ex.( certify that I(we)occupied as my(our)principal
place of residence or a:i(are)buying the following described real property under contract for which a Homestead Property Tax Standard
Deduction is hereby claimed on the date this application is signed, (date of signature). I(We):
[yawn. ❑ Am(are)buying under recorded contract.
❑ Am (are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation.
❑ Have a beneficial interest in the trust or the right to occupy the property under the terms of a qualified personal residence trust.
❑ Am (are)the shareholder, partner, or member of the entity that owns the property.
_
Recorder's office where contract is recorded Record number Page
-
PROPERTY DESCRIPTION
County! Township Taxing district(city.(own,township)
PIY5(Yt f ` ACelz:Wq
Parcel number Legal description Is the property In question:
;"I -041eti ElReal property itC4ally assessed mobile home(IC 6-1.1.7)
II rtion of the residential structure or the land not exceeding one(1)acre that immediately surrounds that structure is used to produce income,describe the use and portion
of the property
4aB toO Q tr5
�I4� "-OO
PROPERTY OWNED ELSEWHERE BY CLAIMANT
State,County.and Township Is claimant vacating omestead?
9 El Yes No
i[Ssg�ature pficiaimant
I hereby certify the above statements are true,correct,and complete. �i E, C.72—_
Address of contact(number and street,city,state,and ZIP code) Address of vacated homestead,if any(number and street,city,state,and ZIP code)
coma-3,2 4)_ Li 5 c. wre ci- 0 r i Atie. r N 7C >to
ASSESSOR USE ONLY I ASSESSED VALUE HOMESTEAD VALUE NON-RESIDENTIAL
VALUE, r
Land not surrounding residential improvements diately rt, , .{ . F,,n.. ,, .
(1)one " ` ,_
Other land (2) ;I4W.7{1�,',*,t n� PT4
Total land(line 1 plus line 2) (3)
«'I Residential improvements or Dwelling (4) t'ftgR ; $ It,; tY4!.
annually assessed mobile l .y=+. .
n manufactured home Garage (5) '", cg sei' t atY •
�fl
��y Other improvements (6) `' ;.''4 Fri``:`e tee V k/ ,/ �/
�� Total improvements(fine 4 through line 6) (7) �r { ar 2'V(/v
`ti Total value (line 3 plus line 7) (8) 6444)
C`Ic SnN natINTY AUPTOP
I hereby certify the above is true,correct, Signature of Assessor Dale signed(month:day.year)
< and complete.
�� Verifying action-Signature of Auditor Date signed(month,day.year)
STANDARD DEDUCTION ALLOWANCE '
20 pay 20 Lesser of 60%of the assessed value of the homestead or 645.000.
Notwithstanding any other provision,the sum of the deductions provided in IC 6-1.f-12 to a mobile home S
that is not assessed as real property or to a manufactured home that is not assessed as real property may
not exceed one-half f 1/2)of the assessed value of the mobile home or manufactured home.
Signature of Auditor ` ' Date signed(month,day.year)
_IILL-4,rj 0J0C---. e- ?/ 7/ 7/4?—.. -
DISTRIBUTION: Original-County Auditor,File-Stamped Copy-Taxpayer
Page i of 2 s, ,
`,8�a`E,osiMANUFACTURED (MOBILE) HOME PERMIT
i ,-illl State Form 7u78(R9/3-20) I
, ; Prescribed'by the Department of Local Government Finance
6 ..
i Type of mobile home permit:
❑ Section A-For Moving XSection B-Transferring Title (NOTE: Separate permits required if owner intends to both move and transfer title.)1
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.
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)
3. 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 lC 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 1(Notice of Placing of Mobile Home Upon Land or Lot)must be filed with the assessor within thirty(30)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 a mobile home that is offered for sale at auction under
IC 9-22-1.5.IC 9-22-1.7,or IC 6-1.1-23.5 for the transfer resulting from the auction.(iC 6-1.1-7-10(a))
8. Documentation provided by person requesting this permit(iC 6-1.1-7-10(d)) Ll State Issued Title Ej Court Order i BMVAffidavit of Sale or Disposal
I 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 mobile home and
the permit is dated not more than ninety(90)days before the date of the proposed move.The mover shall visibly display the permit while the motile home
is in transit.The mover must return the permit to the owner of the mobile home when the move is completed. IC 6-1.1-7-11
Name of owner's agent.if there is an agent acting on the owner's behalf I Agent's telephone number
(
SECTION A- MOVING PERMIT
Name of owner Date of issuance of permit(month.day year)
l �
Address(number and.street.city.state.and ZIP code) i Date permit expires(ninety(90)days after issuance)
so,,,,,u,,,,,,,,
VZ, T roppil hcOe i• i Yea Dimension Vehicle identification number
• I Abdress'Of*reSen'lo:ation?v bet and street.city.state.and ZIP code) i Affected parcel number
A a ,new;Iocatign i i' end street.city.state.and ZIP code)
-. ry,,gf•, j /Ccraact telephone\ number
...)\/
i _Y 10
�
= ,"
PLEASE TYPE OR PRINT INFORMATION G 4 6 6 4 7 2 5
REQUIREMENTS: Federal and State law requires that you state the mileage in connection with the transfer of ownership. Failing to complete this form,or providing a-
any false statements may result in fines and/or imprisonment.
TO SELLER: Seller is responsible for completing this form. If title is issued in more than one name,all owners listed on the title must sign as Seller. Do not
sign as a Seller until all areas of the assignment are completed. Any person signing on behalf of a company must state their position.
TO PURCHASER: You must apply for a new certificate of title within forty-five days of the date of purchase,or pay an administrative penalty.All liens,mortgages or
other encumbrances shown on the face of this title must be released before you apply for a new title.
I/we,as Seller,certify that to the best of my/our knowledge the information contained -- No
knowledge the information contained on this document I II_ I I , I I I I I_
is true and correct and that the odometer now reads ddress
and is the ACTUAL MILEAGE of the vehicle unless one
of the following statements is checked. —
The odometer reading stated is in excess of its The odometer reading is not act,i.r City State ?Zip Code
Li mechamca units. mileage WARNING ODOMEIER DISCREPANT Holder of lien,mortgage or encumbrance(if applicable)
Name of Dealership
—... . Address
Signature
— x-------- City State Zip Code
Printed Name
--_-__ I AM AWARE OF THE ABOVE ODOMETER CERTIFICATION MADE BY THE SELLER(S)
Position Dealer Number Signature of Purchaser Printed Name of Purchaser
Date of Sale Imam,day,year)
SECOND RE-ASSIGNMENT BY REGISTERED DEALER ONLY
I/we,as Seller,certify that to the best of my/our 1 I I I I Name of Purchaser 'Dealer Number
knowledge the information contained on this document Fir I I I ,L I i I L. 1 It
is true and correct and that the odometer now reads
and is the ACTUAL MILEAGE of the vehicle unless one Address
of the following statements is checked. —--
(( The odometer reading is not actual City State Zip Code
�� � WA
mechanical limits. mileage
The odometer readingstated is in excess of its E
WARNING ODOMETER DISCREPANCY. - _.. - --_- - --- - -- a — ---- ---- — - -
— — - -- Holder of lien,mortgage or encumbrance(if applicable)
Name of Dealership
--._ Address
Signature
._. _-._.__. _.__-- --- -_-- --- City (State Zip Code
Printed Name
I
I AM AWARE OF THE ABOVE ODOMETER CERTIFICATION MADE BY TIIE SELLER(S)
Position Dealer Number Signature of Purchaser Printed Name of Purchaser
Date of Sale(north,day,year)
THIRD RE-ASSIGNMENT BY REGISTERED DEALER ONLY
I/we,as Seller,certify that to the best of my/our _ Name of Purchaser Dealer Number
knowledge the information contained on this document [
11 1 f (I rill
is true and correct and that the odometer now reads I J L I l I. Address
and is the ACTUAL MILEAGE of the vehicle unless one
of the following statements is checked. - - —
r-i The odometer reading stated is in excess of its The odometer reading is not actual City State [Zip Code
I 1 mechanical limits. [] mileage -
_ _ _ - WARNING ODOMETER DISCREPANCY. --
Holder of lien,mortgage or encumbrance(if applicable)
Name of Dealership
_. Address -- —
Signature
City State Zip Code
Printed Name
I AM AWARE OF THE ABOVE ODOMETER CERTIFICATION MADE BY THE SELLER(S)
Position Dealer Number Signature of Purchaser Printed Name of Purchaser
Date of Sale ayeetn,day,read
_- - NO ADDITIONAL RE-ASSIGNMENTS PERMITTED