50-293 (12-03) [32.03]
REQUEST TO TAXING UNIT FOR STATEMENT OF UNPAID TAXES ON MANUFACTURED HOME
Request from (name): Request to (taxing unit name):
Address:
Address:
City, state, ZIP code + 4:
City, state, ZIP code + 4:
Phone (area code and number):
Fax (area code and number):
Phone (area code and number):
Fax (area code and number):
Date of request: ________ / ________ / ________
Date of statement of unpaid taxes*: ________ / ________ / ________ Property account number:
Step 1: Owner's name and address
Owner's name:
Current mailing address (number and street):
City, state, ZIP code + 4:
Phone (area code and number):
Step 2: Describe the property
Property description:
Make: __________________________________ Model: _________________________ Year Built: _____________ Serial Number or HUD Label Number: _______________________________________________________________
Step 3: Location of manufactured home Step 4: Unpaid Taxes (Taxing unit completes Steps 4 and 5. Complete and attach Schedule A for current taxes.)
Physical address: _________________________________________________________________________________ __________________________________________________________________________________________________ This is to certify that, after a careful check of the tax records of the taxing unit where the manufactured home is located, the following current taxes and delinquent taxes, penalties and interest are due on the described property: Total current taxes due on this described property
Year delinquent 1. _______________________ 2. _______________________ 3. _______________________ 4. _______________________ 5. _______________________ 6. _______________________ Delinquent taxes, penalties & interest $ _____________________________ $ _____________________________ $ _____________________________ $ _____________________________ $ _____________________________ $ _____________________________
$__________________
Total delinquent taxes
$________________________
Total current and delinquent taxes $________________________
Step 5: Signature of taxing unit collector
Date
Title
* In place of this written statement, the unit's collector may provide a tax certificate or tax bill showing taxes, penalties and interest due on the manufactured home. The chief appraiser/county tax collector must return a written statement of unpaid taxes to the individual that requested the information within five days of the request. If taxes, penalties and interest are due on the manufactured home and are not reported within the required period to the chief appraiser/county tax collector, the bona fide purchaser or the lien holder on a manufactured home is not liable for the taxes, penalties and interest. See Schedule A: Statement of Current Taxes on Manufactured Home about current or estimated current year taxes.