Mobile Home_Miller (3) ,. � CLAIM FOR HOMESTEAD PROPERTY TAX 1 YEAR
STANDARD I SUPPLEMENTAL DEDUCTION FORM
'/ State Form 5473(R17/1-16) HC10 2019
./ Prescribed by the Department of Local Government Finance - -
INSTRUCTIONS See reverse side for filing instructions.
NOTE Telephone,Social Secunty,driver's license,state identification and federal identification numbers are confidential under IC 6-1.1-12-37.
CERTIFICATION STATEMENT
I(We) Rex/Janette Miller 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, 12/13/2018 -_ - (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.
If buying on contract.Fee Simple owner's name 1111 jtt, '4.N
Recorder's office where contract is recorded , , �',Record number Page
GO‘.
`PROPERTY DESCRIPTION
County Township Taxing distric ivsr town,township)
Gibson Ft. Branch Ft. Branch
Parcel number Legal description Is the properly in question:
-26-426-051329-430 0 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 used to produce income,describe the use and portion
of the property utilized to produce income.
4 lQ - `-4.`e-50s -(f0
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. kitt mJlrrt
Address of contact(number and street,city,state,and ZIP code) Address of vacated homestead,if any(number and street,city,state,and ZIP code)
508 N. Railroad St., Lot 1, Ft. Branch, In 47648
ASSESSOR USE ONLY ASSESSED VALUE ' HOMESTEAD VALUE NON-RESIDENTIAL
VALUE
Land not exceeding one(1)acre immediately (1)
surrounding residential improvements
Other land (2)
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)
ohm i d, 12/13/19
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 $ e�
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 the mobile home or manufactured home. )?175
0)
Signature of Auditor Date signed(month,day,year) O
,6 . ,. 12/13/19 ^/
DISTRIBUTION: Original-County Auditor,File-Stamped Copy-Taxpayer
Page 1 of 2 N
a ', MANUFACTURED (MOBILE) HOME PERMIT
' :) State Form 7878(R8/11-17)
��� Prescribed by the Department of Local Government Finance
Type of mobile home permit:
❑Section A-For Moving Section B-Transferring Title (NOTE: Separate permits required if owner intends to both move and trar9`er r•t:•• :
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 1C 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 ❑l BMV Affidavit of Sale or D,sposai
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 nurg,arr�ra7��^
1Ji5 - 4� J
SECTION A-MOVING PERMIT . . •'"" :-s ^'"` .
Name of owner Date of issuance of permit(montgbday y '-': 1••,
tF* 1'. . 3 0'
Address(number and street,city,state,and ZIP code) Date permit expires(ninety(90j ds• e. suance
X
Vehicle identification number
Make of mobile home Year Dimension \ ' NO
Address of present location(number and street,city,state,and ZIP code) Affected parcel number i.'\:%•'
~
Address of new location(number and street,city,state,and ZIP code) Contact telephone number
( ) 1
'`` ;; _
Name of Dealership
Name of Lienholder(if applicable)
-ignature
IL _ Address
-inted Name
City State Zip Code
Position Dealer Number I
I AM AWARE OF THE ABOVE ODOMETER CERTIFICATION MADE BY THE SELLER(S)
Date of Sale(north,clay,rears Signature of Purchaser Printed Name of Purchaser
1.
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 Dealer Number
MILEAGE of the vehide unless one of the following statements is checked.
_ I rl I liII ri The odometer reading stated is in excess of Its Address
mechanical limits.
•
li..-
f The odometer reading is not actual mileage ---------- ---- ------ -
`-1 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
7 I AM AWARE OF THE ABOVE ODOMETER CERTIFICATION MADE BY THE SELLER(S)
Date of Sale booth,day,rea•( Signature of Purchaser Printed Name of Purchaser
f THIRD RE-ASSIGNMENT BY REGISTERED DEALER ONLY
I certify to the best of my knowledge that the odometer reading is the ACTUAL Name of Purchaser !Dealer Number
MILEAGE of the vehide unless one of the following statements is checked.
ode LJ I II , C-1 L-J[ I II The odometer reading stated is in excess of its Address
-- -_-J CJ mechanical limits.
ri The odometer reading is not actual mileage -- ---- -- -- -
WARNING ODOMETER DISCREPANCY. City State 'Zip Code
f Name of Dealership
Name of Lienholder(if applicable)
Signature
- — — Address —...inted Name
• City State Zip Code
Isition (Dealer Number _
1 1AM AWARE OF THE ABOVE ODOMETER CERTIFICATION MADE BY THE SELLER(S)
Date of Sale'noon,day,year, Signature of Purchaser Printed Name of Purchaser
y -
, Ir - +; n
rij _ . ,, i f 3 .'' NO ADDITIONAL RE ASSIGNMENTS PERMITTED 1. . 4 `'. i/. \� :i, \ %i` �I cz. �.--