Mobile Home_Holding + ,.R,,,o CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
I 1 STANDARD/SUPPLEMENTAL DEDUCTION FORM 2 �l\�
1:,� State Form 5473(RIB/1-20) HC10 7-6
1
\ -r- / 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) Q.. , a • • ..rarsi , II certify that I(we)occupied as my(our)principal \
place of residence.r am(are)buying the following describe. --I property under contract for which a Homestead Property Tax Standard 0 Jw
Deduction, d is hereby claimed on the date this application is signed, —1S—a 0Y' (date of signature). I(We):
11d'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 ,%p2�`'^fla // , r
Recorder's office where • tract is reco• d Gifteitil�lrpbe� Page
- - DJ-073/- U "r1/(,o NTy ,
PROPERTY DESCRIPTION
Cou Township Taxing district(city,town,township)
e( bsc(Th. P aunc-e# -P o nc\-ors.
Parcel number Legal description Is the property in question'
O��
❑Real property nnually assessed mobile home(IC 6-1.1-t
If any portion of the residential structure or the land not exceeding one(1)acre that immediately surrounds that structure is used to produce income,describe the use and portion
of the property utilized to produce income.
PROPERTY OWNED ELSEWHERE BY CLAIMANT
State,County,and _ Is claimant vacating a mestead?
C71 �J, Q�t /�C ❑ Yes [�,+
`ature of clai ant
I hereby certify the above statements are true,correct,and complete. I '
At
Address of contact(number and street,city,state,and ZIP code) Address of 1.acated homestead,if any number and street,city,sta and ZIP code)
Sal P• r . -lip a • —1 • •
ASSESSOR USE ONLY ASSESSED VALUE HOMESTEAD VALUE NON-RESIDENTIAL
VALUE
(...... Land not exceeding one Ill acre immediately '
E surrounding residential improvements _ (1)
('�(/ Other land (2)
(wr
* Total land(line 1 plus line 2) (3)
Residential improvements or Dwelling (4)
annually assessed mobile/
manufactured home Garage (5)
Other improvements (6)
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 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 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(12)of the assessed value of the mobile home or manufactured home.
Signature of Auditor � �� �� Date signed(month day year)
/G)90 Lk
DISTRIBUTION: Original-County Auditor,File-Stamped Copy-Taxpayer
Page 1 of '2
cp Q� MANUFACTURED (MOBILE) HOME PERMIT
ga COPY
' `Jt y State Form 7878(R8/11-17)
wePrescribed by the Department of Local Government Finance
Ill. •
Type of mobile home permit
L
❑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. (lC 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
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)
..ddress(rAfrenend,sjreet.city state.and ZIP code) Date permit expires(ninety(90)days after issuance)
ASUR ,
Male?;•tS&g:od ho ..• O Year Dimension Vehicle identification number
At5eisSpEnt I cation(hur*e1 tract street city state and ZIP code) Affected parcel number
PTV A of-riew location(nu +jnb ,aad sfreet.city state,and ZIP code)
•• r ;% \� ; Contact telephone number
( )
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