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15‐DPT‐AR MH 110 05/12 AUTHENTICATION/CERTIFICATION – MANUFACTURED HOME TAX (Authentication of Paid Ad Valorem Taxes) The undersigned certifies under penalty of perjury that the following information is true and correct to the best of his/her knowledge. Check Appropriate Box: Movement Title Change Affixing to Land Destroyed Into/Out of Inventory Permit/Authentication Date CURRENT INFORMATION: County Parcel/Schedule Name of Owner(s) of Manufactured Current Address of Manufactured Park Name/Name of Land Legal Description or Site Manufactured Home Information: VIN Year Title HUD Tag Make SALE INFORMATION: Name of Purchaser(s) of Manufactured Mailing Address of Physical Address of Manufactured Park Name/Name of Land Legal Description or Site Sales Sales Assessor’s MOVEMENT TO: If home is being moved, list the following information: Destination Out of Within New Address of Manufactured Park Name/Name of Land Legal Description or Site MOVER INFORMATION: Name of Mover Transport Check Appropriate: Mover Agent Owner Other Authentication Date: Anticipated Moving Permit Expiration Print Name of Person Telephone COUNTY ASSESSOR INFORMATION Tax Check if Intra County Move: (if box checked, no proration) Actual Value: Assessed Value: divided by 12 months or total days per year: $ (prorated assessed value per month or per day) Multiply the prorated assessed value by the number of taxable months or days: (prorated assessed value) Multiply the prorated assessed value by the current mill levy of: Taxes Assessor or Staff COUNTY TREASURER INFORMATION Due Paid Date Tax Prior Year’s Taxes prorated: Certificate/Permit Fees Total Due: I certify that all ad valorem taxes due this county applicable to the above described manufactured home have been paid through the current tax year including any tax due. Date:_____________Treasurer or Deputy SIGN SIGN SIGN ---PAGE BREAK--- 15‐DPT‐AR MH 110 05/12 AUTHENTICATION/CERTIFICATION – MANUFACTURED HOME TAX (Authentication of Paid Ad Valorem Taxes) REQUIREMENT INFORMATION Manufactured homes that will be moved within a county or out of a county must show proof of paid ad valorem taxes. After notification to the county treasurer/assessor of intent to move a manufactured home, an Authentication of Paid Ad Valorem Taxes may serve as a permit for movement of manufactured homes on public streets or highways under the county’s jurisdiction. The county treasurer/ assessor must issue a transportable manufactured home permit in addition to the Authentication of Paid Ad Valorem Taxes, § 42-4-510 C.R.S. No owner or holder of permits of a manufactured home shall move or provide the movement without being the holder of an Authentication of Paid Ad Valorem Taxes, 42-4-510(2)(b)(III) and (IV), C.R.S. All property taxes levied become due and payable to the county where the manufactured home was located prior to movement, 39-5-204 and 205, C.R.S. The owner of a manufactured home that is removed from its permanent location must record a Certificate of Removal and show proof that taxes are paid by a Certificate of Taxes Due or an Authentication of Paid Ad Valorem Taxes, § 38-29-203(2)(e), C.R.S. The county treasurer/assessor must forward copies of the Authentication of Paid Ad Valorem Taxes to the assessor of the destination county, § 42-4-510(2)(b)(III), C.R.S. Proof of paid ad valorem taxes must be shown when a manufactured home ownership changes or a new Certificate of Title is issued for a manufactured home which a Certificate of Title had been issued. When changing ownership of a manufactured home or when a new Certificate of Title is issued, an Authentication of Paid Ad Valorem Taxes or Certificate of Taxes Due must be issued by the county treasurer/assessor in which the manufactured home is located, showing proof that property taxes have been collected, § 38-29-107, C.R.S. Title 23.1 of the Department of Revenue requires that a proof of Authentication of Paid Ad Valorem Taxes must be provided to the Department prior to obtaining a new Certificate of Title. A Certificate of Permanent Location must be recorded along with proof of paid ad valorem taxes when a manufactured home is permanently affixed to the ground so it is no longer capable of being drawn of the public highways. The owner of a manufactured home that is permanently affixed to the land must record a Certificate of Permanent Location and show proof that taxes are paid by a Certificate of Taxes Due or an Authentication of Paid Ad Valorem Taxes, § 38-29-202(2)(e), C.R.S, A Certificate of Destruction must be recorded along with proof of paid ad valorem taxes when a manufactured home is destroyed. The owner of a manufactured home that will be demolished must record a Certificate of Destruction and show proof that taxes are paid by a Certificate of Taxes Due or an Authentication of Paid Ad Valorem, § 38-29-204(2)(e), C.R.S. An Authentication of Paid Ad Valorem taxes is not required when a manufactured home is deemed materially dangerous or hazardous by a governmental entity, § 38-29-204(1)(d), C.R.S.