HomeMy WebLinkAboutOctober 13, 2007
RECEiVED
OCT 1 7 2001
INSTRUCTIONS ~OR^ OFFiCe:
ASSES;:);:) '"
8SHKOSH WISCONSIN
MOBilE HOME PARK OPERA TOR (or owner of land;( mobile home subject to fee is located outside of park): omplete ~ectlon A with mobile
home owner. Submit in duplicate to your local Assessor within 5 days of the arrival of each mobile home.
MOBilE HOME STATEMENT OF MONTHLY PARKING PERMIT FEE
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.
TO BE
COMPLETED
BY
PARK
OPERATOR
AND
MOBilE
HOME
OWNER
ASSESSOR
NAME OF PARK
Patrician
COUNlY
Winnebago
NAME Of MOBILE HOME OWNER
James and Katrina Border
ADDRESS OF PARK
Virginian Street
ADDRESS Of i.toellE HOME
1518 Indigo Drive
MOBilE HOME DESCRJPnON
MODel OR POPUlAR NAME
Rollohome R067771
PURCHASE PRICE PURCHASED AS WHERE PURCHASED
2007 $27,500.00 ONEW ~UsEO Private
LICENSE NO. (IF APPUCASlE) W1DlH lENGlH WEIGHT COLOR
------------ 16 FT. 80 FT. ---------
NO. OF AXlES
ARRIVAL DATE
11/1/07
I
\
MANUFACTURER.S NAME
Wick
YR Of MANUFACTURE
1995
00 YOU HAVE
o BH..l OF SAlE
NO. OF ROOMS
BAlHS --2-: BORM$. 3--
o FIREPLACE
I
'* WASHER
'* DRYER ~
o PORCH
o PATIO
o CAAPORT
_SF
_SF
SF
TOTAL ROOMS 7
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. 0/0 level of LocaJ Assessment X
(established for preceding Jan. 1 assessment) (Enter month)
6. Value for Fee Computation (multiply line 4 by nne 5) $ and is due on or before
CLERK
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) $ (Entllf the following month)
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.
('.~' ?Iq 09-92)
W1aconaln Oepartmenl 01 Rev""u"