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Manufactured And Mobile Home Conveyance Fee Statement Of Value And Receipt DTE 100M - Ohio
| Manufactured And Mobile Home Conveyance Fee Statement Of Value And Receipt Form. This is a Ohio form and can be used in Revaluation Statewide . |
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DTE FORM 100M (Prescribed 10/99) MANUFACTURED AND MOBILE HOME CONVEYANCE FEE STATEMENT OF VALUE AND RECEIPT If exempt by O.R.C. 319.54(F)(3), Use DTE Form 100M(EX) FOR COUNTY AUDITOR'S USE ONLY Tax List Year County Number Tax Dist. Number Date Home Located in __________________________________________________________________ Taxing District Number Name on Tax Duplicate _________________________________________ Tax Duplicate Year _______________ Neigh. Code Description of Home: Year Mfg. ____________ Certificate Of Title No. _________________________ Value Make: ________________ Serial No. ____________________________ Registration No. _________________ Consideration GRANTEE (BUYER) OR REPRESENTATIVE MUST COMPLETE ALL QUESTIONS IN THIS SECTION. TYPE OR PRINT ALL INFORMATION. SEE INSTRUCTIONS ON REVERSE 1. Grantor's (Seller) Name __________________________________________ Phone: ___________________ 2. Grantee's (Buyer) Name __________________________________________ Phone: ___________________ Grantee's Address _________________________________________________________________________ 3. Address of Home Before Transfer ____________________________________________________________ 4. Address of Home After Transfer _____________________________________________________________ 5. Tax Billing Address _______________________________________________________________________ 6. Conditions of Sale (Check all that apply): ¨ Buyer and Seller are Related ¨ Part Interest Transfer ¨ Trade ¨ Gift ¨ Other: _______________________________________________________ 7. a) Cash Paid (If any). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $___________________ b) New Debt (Loan) Amount (If any) .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $___________________ c) Loan Balance Assumed (If any). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$___________________ d) Total Consideration (Amount Paid) (Add Lines 7a, 7b and 7c) . . . . . . . . . . . . . . . $___________________ e) Portion, if any, of total amount paid for items other than the home . . . . . . . . . . . . .$___________________ f) Consideration for home on which fee is to be paid (7d minus 7e) . . . . . . . . . . . . . $___________________ g) Name of Lender (If Any) _____________________________________________ h) If gift, in whole or part, estimated market value of the home . . . . . . . .. . . . . . . . . . $___________________ 8. Has the grantor indicated that this property is entitled to receive the senior citizen, disabled person, or surviving spouse homestead exemption for the current tax year? ¨ YES ¨ NO. If yes, complete DTE Form 101. 9. Application for 2 1/2% Reduction (NOTICE: failure to complete this application prohibits the owner from receiving this reduction until another proper and timely application is filed): Will this property be grantee's (buyer's) principal residence by January 1 of next year? ¨ YES ¨ NO. I DECLARE UNDER PENALTIES OF PERJURY THAT THIS STATEMENT HAS BEEN EXAMINED BY ME AND TO THE BEST OF MY KNOWLEDGE AND BELIEF IT IS A TRUE, CORRECT AND COMPLETE STATEMENT. _________________________________________________ SIGNATURE of GRANTEE or REPRESENTATIVE __________________________________ DATE -----------Receipt Number RECEIPT FOR PAYMENT OF CONVEYANCE FEE The conveyance fee required by section 319.54(F)(3) R.C., and, if applicable, the fee required by Chapter 322 R.C., in the total amount of $ ____________________has been paid by _______________________________________________________ and received by the __________________________________________ County Auditor. ________________________________________________ COUNTY AUDITOR DATE ___________________________________ American LegalNet, Inc. www.FormsWorkflow.com
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