HomeMy WebLinkAboutSeptember 22, 2008
MANUFACTURED & MOBILE HOME STATEMENT OF ~CE~VED
MONTHLY MUNICIPAL PERMIT FEE ~ ~ ~ ~
INSTRUCTIONS Assi:sso~. ;•.: _•
OSHKOSH, w. `'^ ^' ~ =
MANUFACTURED 8 MOBILE HOME COMMUNITY OPERATOR (orownerof/and i(mancrfactured ormobile home subject
to fee is located outside of community): Complete Section A with manufactured or mobile home owner. Submit in duplicate
to your local Assessor within 5 days of the arrival of each unit.
ASSESSOR: Complete Section B. Determine the fair market value of the manufactured or mobile home. (Use PA-117,
Manufactured 8 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 municipal permit fee.
CLERK: Complete Section C.
SECTION A
TAXATION DISTRICT SCHOOL DISTRICT COUNTY N E OF MANUFACTURED OR MOBILE HOME OWNER
_.____---_------- - n
NAME OF COMMUNITY ~ ~ -----•~ _
TO BE AD RESS OF ANUFACTURED OR MOBILE HOME r'
COMPLETED ~~-~--i~~~--.~.~L
COMMUNIT ADDRESS ARRIVA DATE OWNE PERMANENT ADDRESS ~ _ ~ ~ - _-'-
BY _ 1 ~ ~ ~~
COMMUNITY
MANUFACTURED Olt MOBILE HOME DESCRIPTION
OPERATOR MANUFACTURER'S NAME
MODEL OR POPULAR NAME SE L NUMBER
AND
YR OF M~U~ACTURE PURCHAS EAR PURCHASE PRICE PURCHASED A f , ~~ ~',
MANUFAC- ----------- ~1.~~ ~`"~.
~~{ .. S WHERE PURCHASED
TURED OR ~---~.-~+~-~_._..1.~.__.A _ ^NEw u ED
DO YOU HAVE LICENSE N0. (IF APPLICABLE)": WID H LENGTH WEIGHT COLO~~
MOBILE ;-,,) BILL OF SALE ! ~ TITLE ~ ~NO OF AXLES
HOME NO.OF ROOMS I DOES THE UNIT HAVE -----1-------------- ------ ---1._.__......._-------'
BATHS BORMS ~,.J SKIRTING ~J FIREPLACE
OWNER •--.... .._-. l_~ PORCH ---- ------
A!R CONDITIONING F'~ - - SF
WASHER l J PATIO SF
TOTAL ROOMS _ ~] DISHWASHER
- U DRYER ~-~ CARPORT
.. -........._._.. -.. ...-. _. - _.__.....__.._._ SF
PLEASE _.. , ....... _-.-_.. -
._
SI ATURE OF UNIT OWNER
IDATE t
SIGN HERE ~
-_ __ __-_- ~ --SECTION B -VALUATION
DATE VIEWED OR INSPECTED
ASSESSOR 1• Total Fair Market Value ............ $
-----_.
2. Exempt Furnishings ............... - $
- .
3. NET FAIR MARKET VALUE ..... $ SIGNATURE OF ASSESSOR
(Subtract line 2 from line 1) -
__._ _ SECTION C -COMPUTATION OF MUNICIPAL PERMIT FEE
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. 1assessment) ---'-------- ---'--
_.._._.
_. -
6. Value for Fee Computation (multiply line 4 by line 5) .... $ (Enter month)
CLERK 7, Net Tax Rate. (after state tax credit) -, ~ ~ -~ and is due on or
(established for preceding Janua 1 assessment before the 1 Oth day of
ry' ) ......... X
8. Annual Fee (multiply line 6 by line 7) .............................. $_ __ _ ____
9. Gross Monthly Fee (divide line 8 by 12 months - ~ (Enter me rorrowrng mourn)
-----~ ---- The monthly fee is
10. Lottery Credit (if applicable) ......................................... -$-•----------•-----------
__ due on or before the
11, Net Monthly Fee (subtract line 10 from line 9) ................ $ 10th day of each
PA-Ile (R. to-orl --------- month thereafter.
Wisconsin Oepartmeni of Revenue