Mobile Home_Chambers (2) CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
STANDARD/SUPPLEMENTAL DEDUCTION FORM
State Form 5473(R17/1-16) HC10 0f
Prescribed by the Department of Local Government Finance 1
INSTRUCTIONS:See reverse side forting instructions.
NOTE:Telephone,Social Security,driver's license,state identification ar-I ferie,al idiYr(fica6'on numbers are confidential under IC 6-1.1-12-37.
CERTIFICATION STATEMENT
I(We) `ei • ;fir certify that I(we)occupied as my(our)principal
place of resid, I:-or-u are)buying the fol.wing described real property under contract for which a Homestead Property Tax Standard
Deduction is -eby claimed on the date this application is signed, (date of signature). I(We):
Own. 0 Am(are)buying under recorded contract.
CIPkrn (are) entitled to ctlpy 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.
CLAIMANT'S INFORMATION
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CONTRACT RECORDED
If buying on contract,Fee Simple owners name
Recorder's office where contract is recorded Record number Page
PROPERTY DESCRIPTION
County Township Taxing district(city town,township)
Parcel number Legal description Is the property in questiop'
❑Real property Annually assessed mobile tame(1C 6-1.1-7)
any portion of the residential structure or the land not exceeding one(1)acre that immediately surrounds tl t structure is used to od income,describe the use and portion
/ e property utilized to produce income.
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PROPERTY OWNED ELSEWHERE BY CLAIMANT
\epci\ 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.
Address of contact(number and street,city,state,and ZIP code) Address Osd estead,if mbar and street,city te,and )
fi 3 r" (� v s —3n -
ASSESSOR USE ONLY ASSESSED VALUE HOMESTEAD VALUE NON-RESIDENTIAL -�-/
VALUE 4 �T"L 3
Land not exceeding one(1)acre immediately 11 I C! Z}
surrounding residential improvements (1) T ■T�
Other land (2) 1__. { ■ ■Total land(line 1 plus line 2) (3) FL ■yI
Residential improvements or Dwelling (4) �� •
, .
VVV annually assessed mobile I Ij ' 120
^(v�l manufactured home Garage (5) r 17 •
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Other improvements (6)
Total improvements(line 4 through line 6) (7)
Total value (line 3 plus line 7) (6) GIBSO COUNTY AUDI FOR
V...),N.
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 ,!r of 60%of the assessed value of the homestead or$45,000.Notwithstanding ny ot the sum of the deductions provided in 1C 6-1.1-12 bile home $that is not asses ed as or to a manufactured home that isnot exceed one-h.,(1ssed value of ' home nanufachrred home. /` ,23 (�
Signature of Auditor ^ Date I y ....
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1 ( 9
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DISTRIBUTION: anginal County' -,Pile-Stamped Copy-Taxpayer ��7/t
Page 1 of 2 i" (�
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.fi`" ' 4• MANUFACTURED (MOBILE) HOME PERMIT copy
Si" ,.. State Form 7878(R8/11-17) +
+ ? Prescribed by the Department of Local Government Finance
ype of mobile home permit:
❑Section A-For Moving ection B-Transferring Title (NOTE: Separate permits required if owner intends to both move and ria-.sf r t h.-
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,orIC 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)) El State Issued Title 1 Court Order L. BMV Affidavit of Sale or D,suu
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 owners agent,if there is an agent acting on the owner's behalf Agent's telephone number
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SECTION A-MOVING PERMIT J>;1j a 0".1/11/0
^ i
r.a ne of owner
Date of issuance of perm t iv,oethy�' fp 0 st:
!ecru.,^
Address(number and street,city.state.and ZIP code) Date permit expires(n♦et,9( a0 g-`-
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Make of mobile home Year Dimension i Vehicle identification nLQb64.. ,r + �+!z Y t,°..,
Address of present location(number and street,citystate,and ZIP code) 'Affected parcel number y ' e'`
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't", t„o!►.. a ,^s
Address of new location(number and street,city,state,and ZIP code) Contact telep .^7;' ;,t•••+''T'
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