Form Pt-41 - Dealer'S Statement Of Sale Of Mobile Home

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PT-41 (rev. 02/00)
DEALER’ S STATEMENT OF SALE OF MOBILE HOME
Pursuant to Georgia Department of Revenue Rule 560-11-9-.03(d), this form is to be completed by the dealer upon the sale of a mobile home after January 1. The dealer shall maintain the “ Dealer’ s
Copy” and provide the purchaser with the remaining copies. The purchaser shall submit this statement to the county tax commissioner at the time the mobile home location permit is obtained. The tax
commissioner shall distribute the copies accordingly.
SECTION A: DEALER INFORMATION
Name:
Georgia ID No.:
Date Mobile Home Sold:
Invoice No.:
Address:
City, State, Zip:
County where dealer located:
SECTION B: PURCHASER INFORMATION
Name:
Address:
City, State, Zip:
County where mobile home is to be located:
Purchase Price:
SECTION C: MOBILE HOME INFORMATION
Make:
Model:
Size:
Model Year:
Manufacturer’ s ID #:
SECTION D: DEALER’ S STATEMENT
Check A. or B. below:
A.. ____ I, as the authorized agent for the mobile home dealer listed above, acknowledge that the mobile home purchased by the taxpayer listed above was not in the dealer’ s inventory
as of January 1, 2_____.
B. _____ I, as the authorized agent for the mobile home dealer listed above, acknowledge that the mobile home purchased by the taxpayer listed above has been or will be included in
the Inventory Section of Form PT-50P required to be returned to the ______________________ County Board of Tax Assessors for tax year 2_____.
_______________________________________________________________________
_____________________________
Signature of Authorized Agent
Date
TAX COMMISSIONER’ S COPY
TAX ASSESSORS COPY
MOTOR VEHICLE DIVISION COPY
PURCHASER’ S COPY
DEALER’ S COPY

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