HomeMy WebLinkAboutOctober 30, 2008MANUFACTURED & MOBILE HOME STATEMENT OF RECEIVED
MONTHLY MUNICIPAL PERMIT FEE NQ~ - 3 ~~
INSTRUCTIONS ASSESSORS OFFICE
OSHKOSH, WISCONSIN
MANUFACTURED & MOBILE HOME COMMUNITY OPERATOR (orownerot/and itmanu/actured ormobile home subject
to tee 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 & 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 0 WNE
_.__-__------------ ~ n
TO BE NAME OF COMMUNITY ADDRESS OFMANUFACTURED OR MOBILE HOME
COMPLETED coMMUNIT• ADDRESS ~ _ _
ARRIVAL DATE OWNER PERMANENT ADDRESS -
COMMUNITY M ~ ~ ~~ I~~
ANUFACTURED OR MOBILE HOME DESCRIPTION
OPERATOR MANUF CTURER'SNAME
MODEL OR POPULAR NAME SERIAL N BER
AND ,
MANUFAC- TR~MANUFACTURE P CHASE YEAR PURCHASE PRICE PURCHA Epq -- yyI.~ERE PURCHASE! ~~ ~~ ~~•
TURED OR ---(~~~:._L.~~ ^NEw ED ~
DO YOU HAVE LICE ENO. (IF APPLI TH LENGTH WEIGHT CpLp ~~~~~.--•-----
MOBILE •.~ BILL OF SALE :. ~ TITLE NO OF AXLES
HOME NO.OF ROOMS jj ---•-' ~ -_- ------ II - _ L.-_.- ......_---•--
I DOES THE UNIT HAVE `--'1"'---~---~-•----~---• --- -
BATHS 80RM5 ___ C, SKIRTING I°
OWNER - - ~~ AIR CONDITIONING ru- FIREPLACE u PORCH __-_-___,_.,-_ SF
TOTAL ROOMS IJ WASHER (-] PATIO
-- . _...... ~~ DISHWASHER ---- - --__. SF
• U DRYER U CARPORT SF
._.........._... _..__... 1____-__...___~..______.._.._-........._-._..._._-_..._-----
PLEASE S'~i~ATURE OF UNIT OWNER - --- ••~ _._- .,..__...-__._._.._........_ _. _. -.,,
SIGN HERE' 1 j onTE -'
1 ~ L~~
-_ ---._-~.._.__._._._._.__ _~SECTtON B -VALUATION
- -----
1. Total Fair Market Value ............ $ DATE VIEWED OR INSPECTED
ASSESSOR
~._.___
2: Exempt Furnishings ............... - $
-----
SIGNATURE OF ASSESSOR ' -
ET 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 tee
5. % Level of Local Assessment ...................... - ~~-• ~ - covers the month of
(established for preceding Jan. 1 assessment) X
(Enter month)
6. Value for Fee Computation (multiply line 4 by line 5) .... $ __
CLERK 7. Net Tax Rate (after state tax credit)
and is due on or
(established for preceding January 1 assessment)..,..,,„ X before the 10th day of
8. Annual Fee (multiply line 6 b line 7 ~-~ ~ ~~
Y ) .............................. $ ____
9. Gross Monthly Fee (divide line 8 b 12 months ^~ • - •-"' (Enter tAe to/lowing mourn)
10. Lottery Credit (if applicable) .......................... -' The monthly fee is
"••••••••••• -$~-~__-_.__ _ due on or before the
11. Nel Monthly Fee (subtract line 10 from line 9) ................ $ ~ -~
10th day of each
PA-ne(R. ~o-o~~ - month thereafter.
Wisco~sm Deoar~mem o~ Revenue