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.