HomeMy WebLinkAboutBLD1994-00136 JEFFERSON COUNTY
OFFICE OF THE ASSESSOR
PLEASE READ THE ENTIRE FORM AND PROVIDE AS MUCH INFORMATION AS POSSIBLE. THIS
WILL HELP US IDENTIFY THE UNIT CORRECTLY AND AVOID DOUBLE TAX ASSESSMENTS. IT WILL
ALSO AID IN PLACING A CORRECT VALUE ON YOUR PROPERTY.
DID YOU APPLY FOR A MOVING PERMIT?: Circle one: YES NO
IN WHICH COUNTY DID YOU APPLY FORA MOVING PERMIT?: ,,/�,,�' yy ' `n
WHAT WAS THE PREVIOUS ADDRESS OF THE MOBILE HOME?: /1/ C/.._C O4 G[i2__-
ECCOVOC15, GC/
WHO WAS THE PREVIOUS OWNER OF THE MOBILE HOME?:Sa/nu Gba,
Previous Owner Mailing Address: 6 4cL?Jl
DID A MOBILE HOME DEALER DELIVER THE MOBILE HOME?: Circle one:leffir NO
WAS THE ADVANCE PROPERTY TAX PAID?: Circle one: YES NO
To which County was the tax paid?
WHAT DATE DID YOU PURCHASE THE MOBILE HOME?: /9
WHAT WAS THE PURCHASE PRICE?:
DOES THIS NEW MOBILE HOME REPLACE A MOBILE HOME?: Circle one: Y S NO
If this i -a replacem t, to whom d where did the previous m bil , home go?
MOBILE HOME OWNERSHIP/OCCUPANT DATA:
NAME(S) C 4Cad A WiCa-A WA
-1-''
MAILING ADDRESS /'. 0 / 59,x 6
CITY jrli/ atta/1'(, / STATE/ZIP CODE L)fL Z -(3a 1/45-
HOME PHONE 3 T -(5'z cL 0 WORK PHONE
NOTE: If you rent the mobile home, give name, address, and telephone number of the owner:
MOBILE HOME DATA:
29'
LENGTH (exclude hitch): 5 CO WIDTH: YEAR: "
MAKE( I' �flV MODEL: dQ ,,ryy C✓Yt--
SERIAL NUMBER:
WILL THE MOBILE HOME BE IN A PARK? (circle one) YES
If you have circled YES, please give PARK NAME, SPACE #, & DATE OF PLACEMENT::
PARK NAME:
SPACE #: DATEPLACED IN PARK:
MOBILE HOME LOCATION- NOT/N A PARK:
Do you own (or are you b v
u �ng) land on which mobile home is located or do you rent the land?
Circle one: OWN BUYING �l RENT
PARCEL # (from your tax statement): c. ( �g 00 ( 3
SITE
FIRE#/ROADSS NAME:: /1/ cd../m dee Alaclito(---zip CODE 9k--3 3
If you rent the land, what is the name and mailing address of the land owner?:
NAME:
ADDRESS:
TELEPHONE NUMBE --
FOR OFFICE USE ONLY
RP Account #:
PP Account #:
Date:
REASON FOR INQUIRY:
Field Visit Excise tax Building Moving
by deputy affidavit permit permit
Dealer report Application Deliquent State transfer
by sale for title taxes report
h:\home\pinc ntr\forms\assesso r.frm