HomeMy WebLinkAboutSeptember 17, 2008MOBILE HOME STATEMENT OF MONTHLY PARKING PERMIT FEE ,- S RECEIYEQ
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INSTRUCTIONS ~ ~ ~',,*
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MOBILE HOME PARK OPERATOR (or owner of land if mobile home subject to tee is lac outside of parkr,'WI$~'~~~(th mobile
home owner. Submit in duplicate to your local Assessor within 5 days of the arrival of each mobile home. '^
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.
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TAXATION DISTRICT SCHOOL DISTRICT NAME OF MOBILE HOME OWNER
Oshkosh Oshkosh Sandra Thew
TO BE NAME OF PARK ADDRESS OF PARK
Patrician Village Virginian Street
COMPLETED COUNTY ARRIVAL DATE ADDRESS of MOBILE HOME
sY Winnebago 10/1/08 1525 Indigo. Drive
MOBILE H OME DESCRIPTION
PARK MANUFACTURER'S NAME MODEL OR POPULAR NAME SERIAL NUMBER
OPERATOR Wick Rollohome 38184
YR OF MANUFACTURE PURCHASE YR PURCHASE PRICE PURCHASED AS WHERE PURCHASED
AND 1088 2008 $32 ~ 000 ~ 00 ^ NEW ~ USED private
MOBILE ~ You HAVE LICENSE NO. (IF APPLICABLE) WIDTH LENGTH WEKiHT COLOR NO.OF AXLES
^ BILL of SALE l] TITLE ---------- 16 FT• 80 ~~ ---- -------- -----
HOME No ~ ROOMS pOEg MOBILE HOME HAVE
OWNER BATHS ~ BORMS. _~ . ~ SKIRTING O FlREPUCE O PORCH SF
AIR CONOmONING t~ WASHER ^ PAT10 SF
TOTAL ROOMS 8 ^ DISHWASHER X DRYER O CARPORT SF
.PLEASE SIGNATURE OF BILE HOME OWNER ~~ ~ (
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SIGN HERE Q/K.G .
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DATE VIEWED OR INSPECTED
1. Total Fair Market Value $
ASSESSOR
2. Facempt Fumishings - $
SIGNATURE OF ASSESSOR
3. NET FAIR MARKET VALUE $
(Subtract line 2 from line 1)
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4. Net Fair Market Value.(from line 3 above) $ The tirst monthly fee
covers the month of
5. % Level of Local Assessment X
(established for preceding Jan. 1 assessment) (Enter month)
Value for Fee Computation (multiply line 4 by line 5) $
6
. 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) $ (Enter the following month)
9. Gross Monthly Fee (divide line 8 by 12 months) $ The monthly fee is due
10. Lottery Credit (if applicable) - $ on ocbefore the 10th
day of each month
11. Net Monthly Fee (subtract line 10 from line 9) $ thereafter.
Wisconsin Department of Revenue