HomeMy WebLinkAboutOctober 11, 2007
MOBILE HOME STATEMENT OF MONTHLY PARKING PERMIT FEE
':if:CEIVED
OCT 1 1 2007
INSTRUCTIONS
,=<s OPFICE
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MOBILE HOME PARK OPERA TOR (or owner of land if mobile home subject to fee is located outside of park): Complete Section A with mobile
home owner. Submit in duplicate to your local Assessor within 5 days of the arrival of each mobile home.
ASSESSOR: Complete SectionS. Determine the fair market value of the mobile home. (Use PA-117, Mot?ile 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.
TO BE
COMPLETED
BY
PARK
OPERATOR
AND
MOBilE
HOME
OWNER
ASSESSOR
TAXATION DISTRICT
City of Oshkosh
NAME OF-PARK
Patrician Village
COUNTY
Winnebago
NAME OF MOBILE HOME OWNER
Dennis and Kath
ADDRESS OF PARK
Hu hes
Vir inian Street
ARRIVAL DATE ADDRESS OF MOBilE HOME
10/01/07 1209 Indi 0 Drive
MOBilE HOME DESCRIPTION
MODEL OR POPUlAR NAME
Rollohome
PURCHASE PRICE
2007 $31 900.00
LICENSE NO. (IF APPLICABLE) WIDTH
MANUFACTURER'S NAME
Wick
.~
'\
.,-'
~
YR OF MANUFACllJRE
2002
DO YOU HAVE
BILL OF SALE ]( T11l.E
NO. OF RO~S
BATHS~ 8ORMS.2
16 FT.
80 FT.
TOTAL ROOMS
DOES MOBILE HOME HAVE
~SKlRT1OO 0 FIREPlACE
o AlR CONDITIONING 0 WASHER
~lSHWASHER 0 DRYER ~
~ryAE OF MOBILE oorf OWNEr ;/)
( /(7 . f['I"'AYf'J~~-
o PORCH
o PATIO
o CARPORT
DATE
_SF
__SF
SF
~
DATE VIEWED OR INSPECTED
1. Total Fair Market Value $
2. Exempt Furnishings - $
3. NET FAIR MARKET VALUE $
(Subtract line 2 from line 1)
SIGNATURE OF ASSESSOR .
4. Net Fair Market Value (from line 3 above) $ The first monthly fee
covers the month of
5. % Level of Local Assessment X
(established for preceding Jan. 1 assessment) (EntM month)
6. Value for Fee Computation (multiply line 4 by line 5) $
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) $ (EntM the following montll)
9. Gross Monthly Fee (divide line 8 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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