Mobile Home_Bruce •
• �N� CLAIM FOR HOMESTEAD PROPERTY TAX 1 YEAR
r STANDARD/SUPPLEMENTAL DEDUCTION FORM 20�
r, State Form 5473(R17!1-16) HC10 .
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):���Ltr, �'Y�l`k.c . L certify that I(we)occupied as my(our)principal
place of 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.
0 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.
Social Security number of claimants spouse(last rive digits) Driver's license I Identification/Other number of claimants spouse(last five dgits) Issuing State
(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 re T p Record number Page
1■■ PROPERTY DESCRIPTION
County Township !^^ T ing district(city,town,township)
JUL 2 4 201 1//wl] )
Parcel number Legal description Is the rty in question:
❑jted property Annually assessed mobile home(IC 6-1.1-7)
If any portion of the residential structure or�)acre that immediately surround/ththat structure is used income,describe the use and portion
l of the property utilized to produce -0 N COUNTY AUDITOR
S�
--- --) 02G -41o&- 9041so - oc?."
PROPERTY OWNED ELSEWHERE BY CLAIMANT
State,County,and Township Is claimant vacating a homestead?
❑ Yes ❑ No '
Signature of claimant
I hereby certify the above statements are true,correct,and complete. `J-
Address of contact{numbarard street city state,and ZIP code) Add vacated homestead,if any(number
,S O C��wdr) b ^3 n '
ASSESSOR USE ONLY ASSESSED VALUE HOMESTEAD VALUE NON-RESIDENTIAL
VALUE \A-9-b o
! `6
Land not exceeding ono(1)acre immediately (1)
surrounding residential improvements ,
Other land (2)
Total land(line 1 plus line 2) (3)
n� Residential improvements or Dwelling (4)
/�Y annually assessed mobile I
I \ VVV manufactured home Garage (5)
�\\ Other improvements (6)
Total improvements(line 4 through line 6) (7)
Total value (line 3 plow line 7) (8)
��J�l 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. I S
Notwithstanding any other provision,the sum of the deductions provided in IC 6-1.1-12 to a mobile home $ I`
that is not assessed as real property or to a manufactured ho -s not assessed as real property may r� I ,
not exceed one-hat(1/2)of the assessed value of the a home or nufactured
home. I`.IC..IAl Ate{
d ,
Signature of Auditor c....s_ ordh,day,
1 �^ �V) DaOe sign7 ( 2-\A 1I4 .a.I xao•
DISTRIBUTION:Original-County Auditor,File-Stamped Copy-Taxpayer ^\J, , )
Page 1 of 2 (/ ) `7vY�
t ..� COPY
., R . MANUFACTURED (MOBILE) HOME PERMIT
a' '4..:;1_,
;;; dt1 State Form 7878(R8/11-17)
�$ ' 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) I
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
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
l�rr, as of purcher Affected parcel number
Address of purchase:(number and street,city,state,and ZIP code) Is purchaser moving this mobile 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 th II taxes due on the mobile home have been paid.
Sigma f Coun surer 6))....„
n County Date signed(m th,day,yeah
Zik.,b_50.,____- 7/e2z-t ici
DISTRIBU ON: Original-Owner of Mobile Home,Copy-County Treasurer,Copy-County Assessor or Township Assessor,if any
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