Application For Mobile Home County Registration Form
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1
2Application For Mobile Home County Registration
North Dakota Century Code ch. 57-55
Return the completed application to the County Director of Tax Equalization in the county where the mobile home is
located. Application must be fi led within 10 days after the mobile home is acquired, moved or fi rst brought into this state.
Application must be fi led to request exemption from mobile home taxation.
1. Name of Owner and Mailing Address
Home Telephone Number
Work Telephone Number
Place of Employment
Name of Lending Institution
Location of Mobile Home
2. Name of Court: ____________________________________________________________________
Lot No.: _____________
City or Township: _____________________________________ School District: _____________________________________
If mobile home is located in rural area and not in a designated mobile home court, provide the legal description in the space
below:
Section: _________________________
Township: _________________________ Range: ___________________________
Description of Mobile Home
3. Make: ____________________________________________
Model _____________________________________________
Model Year: ____________
Serial Number: ______________________
Size of Mobile Home: Width: _______________
Length (Excluding hitch): _______________
Slide out or
addition(s) _______ x _______ , _______ x _______ , Entry shed _______ x _______ , Garage _______ x _______
Request for Exempt Status
4. Mobile home qualifi es for exemption based on item # __________ (listed on back of application). Evidence to support the claim
is included with the application or provided to tax director.
Transfer Information
5. Date Acquired: ____________________________________
Purchase Price: _______________________________________
Purchased From:
________________________________________________________________________________________
Date Brought into North Dakota: ______________________ Date Occupied: _______________________________________
Yes
No
6. Was the North Dakota tax permit on this mobile home paid last year?
If Yes, in what County? _____________________ Tax/Refund Receipt No.: ______________ Expiration Date: _____________
Date Moved: __________________
Location of Mobile Home Before Move _______________________________________
7. If mobile home is a rental unit, please furnish name of renter: ______________________________________________________
I certify that the information contained in this application is correct to the best of my knowledge.
This Application Must Be Signed ____________________________________________________________
Signature of Mobile Home Owner
Date
24774
(Revised 2/12)
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