HomeMy WebLinkAboutAugust 23, 2007
OBIL.E HOME STATEMENT
':~ECEiVED
AUG 2 4 2007
INSTRUCTIONS "~<::.;~S OFFICE
::;"',,:S~ V\'ISCONSIN
J81LE HOME PARK OPERATOR (or owner of land if mobils horns subjsct to fss is/oealsd pUIsids of park):. Complete Section A with mobile
me owner. Submit in duplicate.to your local Assessor within 5 days of the arrival of each mobile home.
iSESSOR: Complete Section B. Determine the fair market value of the mobile home. (Usa PA-117. Mobile Home Valuation
Jrksheet). NOTE: Exempt furnishings must be subtracted from the fair market value ii included in that figure. Submit form to local Clerk
computation of parking permit fea.
.ERK: Complete Section C.
TO BE
COMPLETED
BY
PARK
OPERATOR
AND
MOBILE
HOME
OWNER
ASSESSOR
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COCfNrY .
Winnebago
NAME OF l.IOBILE HOl.lE OWNER
. lZ. U (Citvl
313'-1
AR'RIVA1;;1;]Qll- AOO'AESS-OFl;IOS1#'Hq;
MOBILE HOME DESCRIPTION
),lOOEl. OR POPULAR NAME
If'(..
NAME OF PARK
Edison Estates
NO. OF AXLES
SERIAL NUMBeR
L I 001'1
WHERE PURCHAseD
l.IANUFACTlJRER'S NA),lE
F I Ge+wood
YR OF UANUFACTlJRE YR. OF PURCHASE
\q,o UDl
00 YOU HAVE LICENSE NO. (IF APPLICABLE)
o BILL OF SALE
NO. O.F ROOMS DOES l.IOBILE HOME HAVE
BA Ti1S BORMS, _ 0 SKIRTING
o AIR CONOITIONING
TOTAL ROOMS 0 DISHWASHER
SIGNATURE OF MOBILE HOME OWNER
COLOR
WIDTi1 LENGTH
I 'i FT. 00 FT.
o PORCH
o PATIO
o CARPORT
OATE
o FIREPLACE
o WASHc:n
o DRYER
SF
SF
SF
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1. Total Fair Market Value $
2. Exempt Furnishings - $
3. NET FAIR MARKET VALUE $
(Subtract Iina 2 from /fna f)
SIGNATURE OF ASSESSOR
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4. Net Fair Market Value (from line 3 above) $ The first monthly fee
covers the month ot
5. % Level of Local Assessment X
(established for preceding Jan. J assessment) (Enter month)
6. Value for Fee Computatlo~ (multiply line 4by line 5) S
CLERK .' and is due on or be fora
7. Net Tax Rate (atter state credits)' the 10th day of
(established for preceding January 1 assessment) X
8. Annual Fee (multiply line 6 by line 7) $ (Enter the tollowinO month)
S .
9. Gross Monthly Fae (divide line 8 by 12 months) .' . The monthly fee is due
10. Lottery Credit (if applicable) -$ on or before the 10th
d'ay of each month
11. Net Monthly Fee (subtract line 10 from line 9) $ thereahar.
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