HomeMy WebLinkAboutBLD1992-00531 •
REFUND REQUEST FORM
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OWNER NAME
CONTRACTOR NAME
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SITE ADDRESS
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BUILDING PERMIT NUMBER
I REQUEST THAT MY APPLICATION FOR A BUILDING PERMIT BE WITHDRAWN
AND ANY REFUND SENT TO THE FOLLOWING NAME AND ADDRESS :
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REASON( S) FOR WITHDRAWING MY APPLICATION ARE AS FOLLOWS :
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SIGNATURE OF APP I ANT DATE
FOR OFFICIAL US i
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wilding Official Amount Date
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Treasurer ' s Check No . Amount Da Sent Sent By
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OFFICE OF TILE ASSESSOR, JEFFERSON COUNTY
MOBILE HOME QUESTIONNAIRE
.
RP Account I
PP Account !1
DATE
Please read the entire form and provide as much information as possible. This will
help us identify the unit correctly and avoid double assessments. It will also aid
in placing a correct value on your property.
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REASON FOR INQUIRY:
Field visit Excise tax Building Moving
by deputy affidavit permit • permit
Dealer report Application Delinquent State transfer
by sale for title taxes report
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MOBILE HOME OWNERSHIP/OCCUPANT DATA
Names) �A+J tl-- Y�\COh �R
t�S-'kO
Street or Box ���! G%+' J \cV \ ST .
City C ull QLYke-- State/Zip
Home phone Work phone' •
Best time to call
(specify home or work)
NOTE: If you rent
// the
[mobile home give name, address, and telephone number of
owner here _ /•'/i/
*****************
MOBILE HOME DATA: `(��j
(0 Width 1 Model Year 1-t-1
Length (exclude hitch)
Make 1� �e_�r�T Model ()Ap.\jtc...tv
Serial number ' W Ol .
************AA***
MOBILE HOME LOCATION - IN PARK
Park name `62-- E1 r
• Space I7 a Date placed in park -1 1\uc
'
(PLEASE COMPLETE REVERSE SIDE)
MOBILE HOME LOCATION - NOT IN A PARK
Do you own (or are buying) land on which mobile home is located or do you
•
rent the land? (CIRCLE) OWN BUYING RENT .
Assessor's Real Property account (parcel) number (The 9 digit number on the tax
statement r valuati/on notice). �7
/ W / 1
What is the streeaddress of this land? -_y)l /0
Street D C___ C/__Q�('
City ,,#..-,_ c_e__,-,L'
If you rent the land what is the name and mailing address of the land owner?
•
Name •
Street or Box
City State/Zip
Telephone number
MOBILE HOME HISTORY y
Date you purchased '(' T \�
Purchase price p aO C).00
How did this mobile home get to its present location:`
Moved into Jefferson County from CX.f`�t.XL- IL_
/� (County or State)
•
Delivered by dealer (name) CA I.-S
Moved from another, Jefferson County .location? YES or N0. If yes, please give
previous address/location.
•
Didn't move - pruchased in place. .Yes or 6.2 i
•
Name of previous owner
Address
City State/Zip
• If moved,was advance tax paid? YES or( O.) If yes. to which County
Doe§ the mobile home replace a previous mobile home at this new location? YES or NO
If this is a replacement, to whom and where did the previous mobile home go?
Thank you for your assistance. If you need help or information about the assessment
of your mobile home call the Assessor's Office at 385-9105. Questions about taxes }
call the Treasurer's Office at 385-9150.
(NOTE: If mobile home is new to this county a valuation notice will be mailed to .
you when it's valued and added to the assessment roll.)
Please send completed form to: JEFFERSON COUNTY ASSESSOR OFFICE
•
PO Box 1220
PORT TOWNSEND, WA 98368