1) COMPLETE THE FORM BELOW WITHIN 14 DAYS

Name
Address
City, State & Zip
Email
Date of purchase
Purchase Price
Location of mobile home:

Prior owner's information

Name
Address
City, State & Zip

2)Date the mobile home was moved into Ellsworth

Description of mobile home
Year
Length
Width
Serial Number

If the mobile home is located on a private lot, please indicate the property owner's name and address:

Name
Address
City, State & Zip

PLEASE ATTACH A COPY OF THE BILL OF SALE TO THIS FORM WHEN SUBMITTED TO THE ASSESSORS OFFICE.