HomeMy WebLinkAboutAugust 6, 2007
MOBILE HOME STATEMENT OF MONTHLY PARKING PERMIT FEE
INSTRUCTIONS
RECEIVED
AUG - 8 2001
MOBilE HOME PARK OPERATOR (or owner of land If moblfe home subject to fee /s/ceated outs/de of pa~;ocmpl&te SeetfAA A with mobile
home owner. Submit In duplicate to your local Assessor within 5 days of the arrival of each mobile ~OSHJ WISCONSn~'
ASSESSOR: Complete Section B. Determine the fair market value of the mobile home. (Use PA-117, Mobile Home Valuation
Worksheet). NOTE: Exempt furnishings must be subtracted from the fair market value If Included in that figure. Submit form to local Clerk
for computation of parking permit fee.
CLERK: Complete Section C.
TOBE
COMPLETED
BY
PARK
OPERATOR
AND
MOBILE
HOME
OWNER
ASSESSOR
CLERK
P....,18 (R. 0lH3)
ARRIVAl DATE
glj
MOBILE HOME DESCRIPTION
MOOEl OR POPUlAR NAME
MANUFACTURER'S NAME
l-\olk'
YR OF MANUFAC RE
ICi~s
PURCHASE YR
2.{.2':1>1
PURCHASE PRICE
I $i,D
00 YOU HAVE LICENSE NO. (IF APPLICABlE)
o BIU OF SALE 0 TITLE
NO. OF ROOMS OOES MOBILE HOME HAVE
BATHS BDRMS. _ 0 SKIRTING
o AIR CONOmONING
TOTAl ROOMS 0 OISHWASHER
SIGNATURE OF MOalLE HOME OWNER
1. Total Fair Market Value $
2. Exempt Furnishings - $
3. NET FAIR MARKET VALUE $
(Subtract line 2 from line 1)
N1~5. OF MOBIl": HOME OWNER
\ 11M \ : JUUi'lCt ILr(h
ADDRESS OF MOBILE HOME
'la E. unn
OWNER PERMANENT ADDRESS
. ~L{5
Qj
PURCHASEO AS
o NEW l2' USED
SERIAl. NUMeER
01 f-t P IOLaf
WHERl: PURCHASED
WIDTH LENGTH WEIGHT
I L.j FT. 10 FT.
COlOR
NO. OF AXLES
o fiREPLACE
o WASHER
o DRYER
o PORCH
o PATIO
o CARPORT
DATE
_SF
_Sf
_Sf
DATE VIEWEO OR INSPECTeD
SIGNATURE OF AssessOR
4. Net Fair Market Value (from line 3 above)
S. % level of Local Assessment X
(established for preceding Jan. 1 assessment)
6. Value for Fee Computation (multiply line 4 by line 5) $
7. Net Tax Rate (after state credits)
(established for preceding January 1 assessment) X
8. Annual Fee (multiply line 6 by line 7)
9. Gross Monthly Fee (divide line 8 by 12 months)
10. Lottery Credit (if applicable)
11. Net Monthly Fee (subtract line 10 from line 9)
$
The first monthly fee
covers the month of
(Enter month)
and is due on or before
the 10th day of
$
$
-$
$
(Enter Ihe foUowlng month)
The monthly fee is due
on or !;lefore the 10th
day of each month
thereafter.
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. WlIcoMIn Oe9&t1menl of Rewnue