HomeMy WebLinkAbout10/23/2008MOBILE HOME STATEMENT OF MONTHLY PARKING PERMIT FEE RECEiL'~
OCT. 2 32008
- INSTRUCTIONS A~GC'~4~ ~• -
MOBILE HOME PARK OPERATOR (or owner o/land it mobile home subject to lee Is located outside of park): Comp ete 5ecflon A with 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 fumiahings must be subtracted from the fair market value if included in that figure. Submit form to Iocai Clerk
for computation of parking permit fee.
CLERK: Complete Section C.
TAXATK)N DISTRICT SCHOOL DISTRICT NAME OF MOBILE HOME OWNER
Oshkosh Oshkosh Kell S ron n
TO BE NAME OF PARK ADDRESS OF PARK
COMPLETED Patrician Villa a Vir inian Street'
COUNTY ARRIVAL DATE ADDRESS OF MOBILE HOME
BY Winnebago 11/1/08 1423 Indio ri e
PARK MOBILE H OME DESCRIPTIO
MANVFACTURER'S NAME MODEL OR POPULAR NAME SERIAL NUMBER
OPERATOR Wick Rollohotne R74848
YR OF MANUFACTURE PURCHASE YR PURCHASE PRICE PURCHASED A5 WHERE PURCHASED
AND 2002 2008 $34, 900.00 ~ NEW ~ useo Flood Homes Inc
MOBILE DO YOU HAVE LICENSE NO. (IF APPLK:ABLE) WIDTH LENOTH WEK3HT COLOR NO.OF AXLES
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HOM O BILL OF SALE O TITLE ----------- 1(j FT. 80 FT. ---- - -------- ------
E ~ OF goOMS DOES MOBILE HOME HAVE
OWNER eATHS L eDRMS. 3 i~SKIRTINO ^ FIREPLACE ~I PORCH SF
(]AIR CONDmONIN(i ~ WASHER ^ PATK) SF
TOTAL ROOMS 6 DISHWASHER DRYER O CARPORT SF
PLEASE SIONATU OF MOB ME O ER DATE
SIGN HERE -
'>::~:.
DATE VIEWED OR INSPECTED
1. Total Fair Market Value $
ASSESSOR
2. Exempt Furnishings - $
810NATURE OF ASSESSOR
3. NET FAIR MARKET VALUE $
(Subtract line 2 from line 1)
.... .. ..
...~
"4
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)
(Enter 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 Fes (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 or before the 10th
day of each month
11. Net Monthly Fee (subtract line 10 from line 9) $ thereafter.
PA•i1B (R. t>9-93) Wisconsin Department of Revenue