HomeMy WebLinkAboutOctober 30, 2008MANUFACTURED & MOBILE HOME STATEMENT OF ~EGE~v~D
MONTHLY MUNICIPAL PERMIT FEE
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INSTRUCTIONS ~v~CRS OGONg~li
MANUFACTURED & MOBILE HOME COMMUNITYOPERATOR (orownerof/anditmanufactured orms~~ipS~~W,$
to fee is located outside of community): Complete Section A with manufactured or mobile home owner. Submit in dupl~/ate
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 & 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 NAME OF MANUFACTURED OR MOBILE HOME OWNE
.n
TO BE NAME OF COMMUNITY %- --- _ _ _ _ _ _ _
ADDRESS OFMANUFACTUREO OR MOBILEHOME
COMPLETED coMMUNIT, ADDRESS ~ __
ARRIVAL DATE OWNER PERMANENT ADDRESS ~ - ----'-'-
BY -~
COMMUNITY t ~ ~t~
MANUFACTURED OR MOBILE HOME DESCRIPTION
OPERATOR MANI~CTURER'SNAME
MODEL OR POPULAR NAME SERIAL NUMBER
AND i '
MA N UFAC- YR ~ ~UFACTURE ~ PURC SE YEAR PURCHASE PRICE PURCHASED S - ~ ~ URC~~~~' ' -
TURED OR ~-- ~~ L.~U ^NEw USED `fit ~-~-Q
00 YOU HA~ ~ - - ~~1J(.f~!~1~ ~ .--------
..... •
LICENSE NO. (IF APPLICABLE); WIDTH LENGTH WEIGH7 COLOR ENO. OF AXLES
MOBILE ;-„~ 81LL OF SALE .- ~ TITLE _
-----------------•------ Fi FT. '
NO. OF ROOMS { --'-""` i
HOME I DOES THE UNIT HAVE - -"-'~-- --.-.~...-•-------•---°-------- -~--- -.- ...--°----
BATHS 80RM5 C, SKIRTING FIREPLACE
OWNER __...... ---- U U PORCH -----._._..---SF
~~ AIR CONDITIONING (~ WASHER r1--~~
TOTAL ROOMS U DISHWASHER I.•.J PATIO -- --- - -- SF
(,, DRYER U CARPORT SF
SI~IATURE OF UNIT OWNER • -- --_--~_.. _._..,.._._..____._..-...___......-....
PLEASE r , ~ ~ DnrE
SIGN HERE' ~~` ~ F
---... --....--..,-.__...-_,..•,.__ SECTION B -VALUATION
1. Total Fair Market Value ............ $ DATE VIEWED OR INSPECTED
ASSESSOR .--_
2. Exempt Furnishings ............... - $
---..-
SIGNATURE OF ASSESSOR ~ •
3. NET FAIR MARKET VALUE ..:.. $
(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
. % Level of Local Assessment ....................................... X _
(established for preceding Jan. 1assessment) ----'`--"-'--'--
6. Value for Fee Computation (multiply line 4 by line 5) .... $ __
CLERK 7. Net. Tax Rate (after state tax credit)
(established for preceding January 1 assessment) .,.,,,,,, X
8. Annual Fee (multiply line~6 by line 7) .............................. $ _
9. Gross Monthly Fee (divide line 8 b 12 months
Y ) .......z. $ ,
-_; .
10. Lottery Credit (if applicable) ......................................... -
$ _.._
et Monthly Fee (subtract line 10 from tine 9) ................ $
_...-
(Enter month)
and is due on or
before the 10th day of
(Enter the Iollowing month)
The monthly fee is
due on or before the
10th day of each
month tharPakar