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Mobile Home_Fisher /•+ .�, CLAIM FOR HOMESTEAD PROPERTY TAX .3 ..`'t STANDARD/SUPPLEMENTAL DEDUCTION FORM YEAR i l' State Form 5473(R18/1-20) HC10 �� �"i,,� 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) © 01 CA certify that I(we)occupied as my(our)principal place o residence or am(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): ❑ 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. ❑ Am (are)the shareholder, partner,or member of the entity that owns the property. 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 Q Taxing district(city town,township) Jail • Parcel number Legal description I I Is the property in question, ❑Real property Annually assessed mobile home(IC 6-I 1.7) If any portion of the residential structure or the land not exceeding one(1)acre that immediately surrounds that structure is us to pr uce income,describe the use and portion of the property utilized to produce income 6,L1c, 0,50,6 - 0o PROPERTY OWNED ELSEWHERE BY CLAIMANT State.County.and Township Is claimant va g a homestead? ❑ Yes o - Signatu e of claimant ,/ '� I hereby certify the above statements are true,correct,and complete. ,-'CU/�C "/, Address of contact(number and street,city sc.an ZIP code Address of vacated homestead,if any(number and street,city,state.and ZIP code) 103--CSmc .` S ti- -fir) 61. g. ASSESSOR USE ONLY I ASSESSED VALUE HOMESTEAD VALUE NON-RESIDENTIAL VALUE Landrrnoting ceding one.(1)acre immediately 11) surrounding residential improvements Other land (2) k ,t l:'-`sL:,4x c '. Total land(line 1 plus line 2) (3) FIL4 II Residential improvements or Dwelling (4) 1,* annually assessed mobile/ — �'i _.., manufactured home Garage (5) Other Improvements (6) J U 41102t-M.404fr Total Improvements(line 4 through line 6) (7) Total value (line 3 plus line 7) (8) I hereby certify the above Is true,correct, Signature ofAgtON COUNTY AUDITOR 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 deductions provided in IC 6-1.1-12 to a mobile home $ 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 va(7)home or manufactured home. Signature of Audit tDate sign (month, , eer) ,, 2 .DISTRIBUTION: Original-County Auditor,File-Scamr /,' Page 1 of 2 / �'lli/ 4`RATj\ MANUFACTURED (MOBILE) HOME PERMIT a State Form 7878(R913-20) t_i,):i •� Prescribed by the Department of Local Government Finance , i Type of mobile 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. 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 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)) ❑ State Issued Title ❑ Court Order ❑ BMV Affidavit of Sale or Disposal j 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 1 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 1 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 owners 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) Add r h��,,,,���c�S(tet C ;�tare.and ZIP code) Date permit expires(ninety(90)days after issuance) Ire 1•rrlobile oee' .S• * ' Year I Dimension Vehicle identification number 4 ,, ``= I d�rG,�s ofe ;in - d street.city.state and ZIP code) i Affected parcel number A rksag6sv Jocation(fnombv-so street.city.state.and ZiP code) I Contact telephone number /V t• ` •.„ (.; - u• . Ztp,*-- DO NOT ACCEPT TITLE SHOWING ANY ERASURES, ALTERATIONS OR MUTILATIONS a. -''' fl,. 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. I (We) certify to the best of my (our) knowledge that the No odometer now reads and is the ACTUAL MILEAGE of the vehicle enths unless one of the following statements is checked. I MILES MILEAGE of the vehicle unless one of the following statements is checked. I ' I E The odometer reading stated is in excess of its Address mechanical limits. The odometer reading is not actual mileage WARNING ODOMETER DISCREPANCY. City State Zip Code 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) Date of Sale(nrxxn,ay,year) Signature of Purchaser Printed Name of Purchaser SECOND RE-ASSIGNMENT BY REGISTERED DEALER ONLY I certify to the best of my knowledge that the odometer reading is the ACTUAL Name of Purchaser IDealer Number MILEAGE of the vehicle unless one of the following statements is checked. e ❑ The odometer reading stated is in excess of its Address mechanical limits. The odometer reading is not actual mileage WARNING ODOMETER DISCREPANCY. City State Zip Code 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) Date of Sale t mnen,ay,year) Signature of Purchaser Printed Name of Purchaser THIRD RE-ASSIGNMENT BY REGISTERED DEALER ONLY I certify to the best or my knowledge that the odometer reading is the ACTUAL Name of Purchaser Dealer Number MILEAGE of the vehicle unless one of the following statements is checked. I I , I II J u 7 The odometer reading stated is in excess of its Address mechanical limits. ❑ The odometer reading is not actual mileage WARNING ODOMETER DISCREPANCY. City State Zip Code 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) Date of Sale imnin,day,year) Signature of Purchaser Printed Name of Purchaser NO ADDITIONAL RE-ASSIGNMENTS PERMITTED