HomeMy WebLinkAboutMarch 20, 2007
MOBILE HOME STATEMENT
INSTRUCTIONS
RECEIVED
MAR 2 2 2001
, .
MOBILE HOME PARK OPERATOR (or owner 01 land il mobile home subject to lee is located?utsIdeolpdrk)~,e5 plete Section' A with mobile'
home owner, Submit in duplicate.to your local Assessor within 5 days ot the arrival of each mobile home.
ASSESSOR: Complete Section B. Determine the fair market value of the mobile home. (Use PA-117, Mobil Home Valuation
Worksheet), NOTE: Exempt furnishings must be subtracted from the fair market value if includ ed in that fig re. Submit form to local Clerk
for computation of parking permit fee,
CLERK: Complete Section C.
TO BE
COMPLETED
BY
PARK
OPERATOR
AND
MOBILE
HOME
OWNER
TAXATION DISTRICT
City of Oshkosh
NAJ.lE OF PARK
Edison Estates
NAJ.lE OF MOBILE HO)./E OWN~R
Q.ob.\l'l ( ,,\ k ',"-lhu 'l \vah.kk.
AOOAESS OF PAR
~ "$I~' 2 (xlu vj?:w
ADORESS OI'MOBICE HOLlE
LI II '4f. \'3;3'
MOBILE HOME DESCRiPTION
J.lOOEI. OR POPUUR NA.\4E
COUNTY
Winnebago
ARRIVAL OAre
IJANUFACTURER'S NAME
fit e rids hI)
YR OF MANUFACTURE
iq~l
00 YOU HAVE
o BILL OF SALE
NO. O.F ROOMS
SA THS_
NO. OF AXLES
PURCHASE PRICE
'2.co1 .~ 1'11-0
LlCENSE NO. (IF APPLICABLE) WIOTH
10 FT.
LENG 111
~.o FT,
CXJES MOSILE HOME HAVE
o SKIRTINO
o AIR CONDITIONING
o OISHWASHER
SIGNATURE OF MOBILE HOME OWNER
o FIRE?LACE
o WASH""
o DRYER
BDRMS. _
SF
_SF
SF
TOTAL ROOI.lS
1. Total Fair Market Value $
ASSESSOR -$
2. Exempt Furnishings SIGNAT'UFU: OF ASSESSOR
3. NET FAIR MARKET VALUE $
(Subtract line 2 from line 1)
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"','s:,,,,~,;;::;*,SEc:ml.o~.~.:..C.;..;.>C.oMB.9Iftt.T~ .\~;..~m)?~E.... ......>... .;...... ........ ...;."....;.;. ..;..
... . .. ,', ......,.}:~:~::~::~:::~:~:;.:*~$?~:~~:::*:~;:~::;::::~~.::*~:;:~~:@;~1:~::*~::~::$:~:?:~::*:4~:*:::;~~~.~~::~..::~~~:~:;~::.~~~:::;::.~~:;;.::~:.~::::::::::~:::~':::~.;::~::::::~::~<.;~;:::::::::::~~~~:::::::~;f.-::~:::::::: :~::::::'" ,',.... ,', ....... ... ,.......,.."...
4. Net Fair Market Value (from line 3 above) $ The first monthly fee
covers the month 01
5. % Lavel of Local Assessment X
(established for preceding Jan. 1 assessment) (Enclt1' month)
6. Value for Fee Computation (multiply line 4 by line 5) S
CLERK .' and is due on or before
7. Net Tax Rate (after state credits)' the 10th day of
(established for preceding January 1 assessment) X
8. Annual Fee (multiply line 6 by line 7) $ (Entlt1' mil (ollowing month)
.
9. Gross Monthly Fee (divide line a by 12 months) $ .' . The monthly fee is due
.'
10. Lottery Credit (if applicable) -$ on or before the 10th
day of each month
11. Net Monthly Fee (subtract line 10 from line 9) $ thereafter.
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