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Mobile Home_Potts 5, --'4-„- CLAIM FOR HOMESTEAD PROPERTY TAX YEAR A . .t, STANDARD/SUPPLEMENTAL DEDUCTION FORM ZZ ¢. State Form 5473(R1811-20) HC70 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) , O k N ., 1.--' -� _ certify that I(we)occupied as my(our)principal place of residence m - buying the folio• g 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): Own. ❑ 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. 0 Am (are)the shareholder, partner, or member of the entity that owns the property. (Applicable only if applicant's spouse does not have a social security number) CONTRACT RECORDED If buying on contract,Fee Simple owner's name Recorder's office where contract is recorded Record number Page PROPERTY DESCRIPTION County Township © ^ Taxing district(city town,township) s ' —— Parcel number Legal descnphon Is the property in question ❑Real property Annually assessed mobile home(IC 6-1 1.7) If any portion of the residential structure or the land not exceeding one(1)acre that immediately surrounds that structure is use o pr uce income.describe the use and portion of the property utilized to produce income to ( -- LI 22 - d S d - --c-i . -- 0 0 PROPERTY OWNED ELSEWHERE BY CLAIMANT State.County.and Township Is claimant valrng a homestead? ❑ Yes I,` No Signature of claimant I hereby certify the above statements are true,correct,and complete. Address of contact(number and street,city state.and ZIP code) A ress of vacated ho stead.d any(number and street,city state.and ZIP code) ASSESSOR USE ONLY I ASSESSED VALUE HOMESTEAD VALUE NON-RESIDENTIAL _ VALUE Land not exceeding one(1)acre immediately (1) T Nsurrounding residential improvements ^. (� Other land (2) `_ ,6 Total land(line 1 plus line 2) (3) _ - - Residential improvements or Dwelling (4) .Y \ annually assessed mobile I �R"rs""' e M. manufactured home Garage (5) _a Other improvements (6) h `-ems c ie c/.....), Total improvements(line 4 through line 6) (7) AUGTotal value (line 3 plus line 7) (8) G I 2022 (Q) I hereby certify the above is true,correct, Signature of Assessor Date signed(month.day year) and complete. ) Verifying action-Signature of Auditor ,/ � "d' Date signed(month,day.year) STANDARD GIBDEDUCTSON COUNTY AUDITOR ION 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 deductions provided in IC 6-1.1-12 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(1/2)of the assessed value of t mo it a or manufactured home. Signature of Auditor (If cdk 1 _ Date si ne Tonfh, a ar)� DISTRIBUTION: Original-County Auditor,File-Stamped Copy- rt% Page 1 of 2 2t k p3 t sr�r t��-E ... ,air $ MANUFACTURED (MOBILE) HOME PERMIT ORIGINAL e Sta te Form 7878(R9/3-20) �,.; Prescribed by the Department cf Local Goi_r _ ?. :ti: Type of mobile home per t• 7 Section A-For Moving Section B -Transferring Title 11OTE. Separate permits r�:-i -a:I if owner intends to both move and transfer title 11 i _ RUCTIONS 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 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 tite 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 o'transfer title to a mobile home does not apply to a mobile home that is offered for sa.'e 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)) 7 State Issued Title Li Court Order I` BMVAffidavit 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 I 1 expires.it becomes invalid and the owner must obtain a new permit. I .-i ATTENTION: MOVER,HAULER,OR TOWER A person who is engaged to move a mobile home may not provide that service unless the owner presents h!m 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 i 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 oscer's behalf 1 Agent's telephone number 1 I i ( ) SECTION A-MOVING PERMIT 1 1 Nlr'rf4 Qtot,R F•. — — — I Date of issuance of permit(month.day year) i A ,r ......� Oli .i!;, r :: 1 and ZiP code) Date pe.rmit expires(ninety(90)days after issuance ` -- — -- — --. • : RI Year I D'm=nson i` ' i i/e n den' ca'on number e 3Lf fJ' ➢• I • bc.d J St of city state and ZIP coda, — — I Affected parcel number�, 2. ef/ yF��W�u+N+N`��� / IP Contact telephone number _.) ,. , , ,.-,-, 1N D FA.N A C ER Tl F IC A-'FEM E: r-";.,--L--,, ,-- -, z f— i - Approved by State Board of Accounts,2016 19347227000159 i S. c DO NOT ACCEPT TITLE SHOWING ANY ERASURES, ALTERATIONS OR MUTILATIONS `('' PLEASE TYPE OR PRINT INFORMATION G Q 2 91 1 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* 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 on this document is true and correct and that the odometer now reads and is the Tenths ACTUAL MILEAGE of the vehide unless one of the following statements is checked. I , MILES LiThe odometer reading stated is in excess of its mechanical limits. U The odometer reading Is not actual mileage WARNING ODOMETER DISCREPANCY. Address and is the ACTUAL MILEAGE of the vehide unless one of the following statements is checked. - -- The odometer reading stated Is in excess of its The odometer reading is not actual City State Zip Code ❑ mechanical limits. ❑ mileage -_ WARNING ODOMETER DISCREPANCY. Holder of lien,mortgage or encumbrance(if applicable) Name of Dealership Signature Address 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 Inontn,aY,Ye.,) SECOND RE-ASSIGNMENT BY REGISTERED DEALER ONLY I/we,as Seller,certify that to the best of my/our ' I I I Name of Purchaser iDealer Number knowledge the information contained on this document is true and correct and that the odometer now reads Address and is the ACTUAL MILEAGE of the vehide unless one of the following statements is checked. -- - - -- The odometer reading Is not actual City State Zip Code ❑The odometer reading stated is In excess of its mechanical limits. ❑ mileageA _ WARNING ODOMETER DISCREPANCY. Name of Dealership Holder of lien,mortgage or encumbrance(if applicable) Signature Address Printed Name City State Zip Code 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(month,ay,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 [ I I- -Ir is true and correct and that the odometer now reads J I ' Address and is the ACTUAL MILEAGE of the vehide unless one of the following statements is checked. - The odometer reading stated is in excess of its The odometer reading is not actual City Sate IZIp Code ❑ mileage I 1-_--__mechanical limits. ----- - -- - - I_ 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 Inontn,a,•,rnaq i 'NO ADDITIONAL RE-ASSIGNMENTS PERMITTED 1