Form Pca373 - Manufactured Home - Affidavit - Placer County Assessor'S Office
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1PLACER COUNTY ASSESSOR’S OFFICE
Kristen Spears, Assessor
2980 Richardson Drive Auburn, CA 95603-2640
Telephone: (530) 889-4300 Fax: (530) 889-4305
Website: E-mail: assessor@placer.ca.gov
Manufactured Home - Affidavit
Name:
Assessment:
Mailing Address
ID Number:
City ST Zip
Mfr. & Year:
Our records indicate that you own this manufactured home and it is located in Placer County. If you have
disposed of this manufactured home or moved it out of the county or state prior to January 1, you must notify
the Assessor’s Office. If you have any questions please call at (530) 889-4300.
By law, the sale, removal, or destruction of property after the lien date (January 1) does not relieve the owner
on January 1 of the tax liability.
MANUFACTURED HOME WAS PERMANENTLY MOVED OUT OF PLACER COUNTY OR OUT OF STATE:
1.
In order to cancel the bill, you must attach a copy of other county’s tax bill or out-of-state registration if
moved prior to January 1.
Date of Move:
(Month)
(Day)
(Year)
New location:
_____
(Street Address)
(City)
(State)
Last year’s taxes were paid to County of / State of:
_____
MANUFACTURED HOME WAS SOLD: Date of Sale:
_____ _ Sale Price: $
___________
2.
(Month-Day-Year)
New owner’s name:
_____
Mailing address:
_____
(Address)
(City)
(State)
(ZIP)
Was the Department of Housing and Community Development (HCD) Notified?
YES
NO
Attach copy of your bill of sale for verification
MANUFACTURED HOME WAS WRECKED, JUNKED, DESTROYED, OR ABANDONED. In order for us to
3.
cancel the tax assessment, return this form with a copy of the HCD documentation, insurance report, or
police report.
I CERTIFY (OR DECLARE) UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF
CALIFORNIA THAT THE FOREGOING IS TRUE AND CORRECT.
________
____________________________________
____________________________________
DATE
NAME (PLEASE PRINT)
SIGNATURE
(_____)______________________________
TELEPHONE NUMBER (8:00 a.m. - 5:00 p.m.)
PCA373 (Rev. 02/27/15) ang
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