Mobile Home_Doerner j., CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
y ` STANDARD/SUPPLEMENTAL DEDUCTIONFORM
aHC10 ��Z
State Form 5473(R18I t-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.
I(We) J O 00,41 ►n 0 certify that I(we)occupied as my(our)principal /
place of residence or am(are)buying th following described real property under contract for which a Homestead Property Tax Standard 0 k
Deduction is hereby claimed on the date this application is signed, (date of signature). I(We):
1
Own. ❑ Am(are)buying under recorded contract.
m (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.
0 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 town,township)
•
Parcel number Legal descnption Is the property in question.
❑Real property Annually assessed mobile home(IC 6-I 1-7)
_ I
If any portion of the residential structure or the land not exceeding one(1)acre that immediately surrounds that stricture is used pr uce income.describe the use and portion
of the property utilized to produce income
4s,— 4/,'2 0307(-f
PROPERTY OWNED ELSEWHERE 8Y CLAIMANT
State,County.and Township Is claimant vac% g a homestead?
--- - -- - - - -.._. -- ❑ Yes No
Signature of claimant
I hereby certify the above statements are true,correct,and complete.
Address of can t(n ber and street.city state.and ZIP code) .Address of vacated homestead.if any(number and street,city.state.and ZIP code)
G 19— Vim- S\- 1* 3 d\A\\ • n '
ASSESSOR USE ONLY I ASSESSED VALUE HOMESTEAD VALUE NON-RESIDENTIAL
VALUE
Land not exceeding one(1)acre immediately rrr
surrounding residential improvements
Other land --.- -.-__ ( k yt.e.'L i'f'yif- r >,7 .
1 Total land line 1(line
plus2)
Residential improvements or Dwelling (4) .r
annually assessed mobile I 'AUG 2 3 2022 —" --+� -^
manufactured home , Garage �}
Other improvements (6) `.;__ *"_ d,A:_7
Total improvements(line 4 through line 6) C G'+
Total value (line 3 plus line 7) GIBSO( )C
013141
I hereby certify the above is true,correct, Signature of Assessor Date 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$45,000
Notwithstanding any other provision,the sum of the deducti vided in IC 6-1.1-12 to a mobile home S
that is not assessed as real property or to a manufactur e t t is not assessed as real property may
not exceed one-half(1/2)of the assessed value of the obile home r manufactured home.
Signature of Auditor „^ Date signed(moot,day year)
�V1 � 1 2 '8 2LI 2
w
DISTRIBUTION: Original-County Auditor,File-Stamped Copy-Taxp I 4 . ////`
�Page 1 of 2
.l1123
,c,:fA'` MANUFACTURED (MOBILE) HOME PERMIT �'
a� t State Form 7878(R9 I 3-20) p
i
\yam`_ Prescribed by the Department of Local Government FinanceORII �` >W�' ' 3
'Si..
Type of mobile home permit:
E Section A-For Moving E 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.
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 1C 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 auctio . (IC 6-1.1-7-10(a))
8. Documentation provided by person requesting this permit(IC 6-1.1-7-10(d)) State Issued Title ❑ Court Order ❑ BMV Affidavit of Sale or Disposal
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 mobile 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 Agent's telephone number
( )
SECTION A-MOVING PERMIT
Name of owner Date of issuance of permit(month,day.year)
g .),„,, `INDIANA CERTIFICATE OF TITLE .•A.... ' ` ,..• ..,
"
,:;
,
PLEASE TYPE OR PRINT INFORMATION
REQUIREMENTS: Federal and State law requires that you state the mileage in connection with the transfer of ownership.Failure to complete,or providing false
statement may result in fines and or imprisonment.
TO SELLER: Seller is responsible for completing form.If title is 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 for a company must state position.
TO PURCHASER: You must apply for a new certificate of title within thirty-one days of the date of purchase,or pay a delinquent penalty fee.All liens shown on the
face of this title must be released before you apply for a new title.We swear or affirm that the information on this form is correct.We understand that a false statement may constitute the crime of perjury.
ur
No
I (We) certify to the best of my (our) knowledge that the enths
odometer now reads and is the ACTUAL MILEAGE of the vehicle MILES
unless one of the following statements is checked.
—
Signature Address
Printed Name City State IZip Code
Position Dealer Number
I AM AWARE OF THE ABOVE ODOMETER CERTIFICATION MADE BY THE SELLER(S)
Signature of Purchaser Printed Name of Purchaser
Date of Sale(morrcn,my,ve,o
SECOND RE-ASSIGNMENT BY REGISTERED DEALER ONLY (Dealer Number
I certify to the best of my knowledge that the odometer reading is the ACTUAL
Name of Purchaser
checked.
MILEAGE of the vehicle unless one of the doeter readang stated is
excess of its Address
III I ,I l l III Thmechanical limits.
The odometer reading is not actual mileage City State Zip Code
WARNING ODOMETER DISCREPANCY.
Name of Dealership Name of Lienholder(if applicable)
Signature Address
Printed Name City (State IZip Code
Position (Dealer Number
I AM AWARE OF THE ABOVE ODOMETER CERTIFICATION MADE BY THE SELLER(S)
Signature of Purchaser Printed Name of Purchaser
Date of Sale(noitt n,day.re,n
THIRD RE-ASSIGNMENT BY REGISTERED DEALER ONLY (Dealer Number
I certify to the best of my knowledge that the odometer reading is the ACTUAL
Name of Purchaser
MILEAGE of the vehicle unless one of the following statements is checked. Address
I I I-11 1 ,1 11 II 1 The odometer reading stated is in excess of its
mechanical limits.
ri The odometer reading is not actual mileage City (state rip Code
WARNING ODOMETER DISCREPANCY.
Name of Dealership Name of Lienholder(if applicable)
Signature Address
Printed Name City (State Zip Code
Position (Dealer Number
I AM AWARE OF THE ABOVE ODOMETER CERTIFICATION MADE BY THE SELLER(S)
Signature of Purchaser Printed Name of Purchaser
Date of Sale(month,day,year)
I NO ADDITIONAL RE-ASSIGNMENTS PERMITTED I