Free 23341.FH11 - Indiana

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NOTICE OF PLACING OF MOBILE HOME UPON LAND OR LOT
State Form 23341 (R3 / 9-08) Prescribed by Department of Local Government Finance

INSTRUCTIONS: To be filed with the assessing official within ten (10) days after the date of placement of the mobile home. A person who violates this requirement commits a Class C infraction. (6-1.1-7-13)
Name of Assessing Official Address (number and street, city, state, and ZIP code) Date (month, day, year)

Pursuant to the provisions of IC 6-1.1-7-3, you are hereby notified that the following mobile home(s) have been permitted to be placed on the land or lot owned, controlled and / or possessed by me.
Legal description of land or lot Address (number and street, city, state, and ZIP code) Township County

NAME OF OWNER

YEAR

MAKE

SIZE

DATE OF PLACEMENT

Signature of owner or possessor of land or lot