HomeMy WebLinkAboutApril 14, 2010 MOBILE HOME STATEMENT
p�.cv( -t;.o RECEIVED
APR 2 0 201Q
INSTRUCTIONS SSSosso
OSHKOSH O FFICE
. W IS CONSIN
MOBILE HOME PARK OPERATOR (or owner of land if mobile home subject to lee Is located outside of park) :•Complete Sectiorf A with mob
home owner. Submit in duplicate.to your local Assessor within 5 days of the arrival of each mobile home.
ASSESSOR: Complete Suction 8. 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 C
for computation of parking permit tae. 4005110 — C /; 1
CLERK: Complete Section C. 1 °
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TAXATION OISTRICT •• MANE OF UOBILE HONE OWNER
City of Oshkosh S ' ( 4 , r •1-e, 4
TO BE HAKE OF PARK • • RE OF PARK
Edison Estates ? i4 (dPn11.,103
COMPLETED COUNTY ARRIVAL GATE AOORESS OF MOBILE HONE
BY Winnebago l'10 — ‘'S
PARK MOBILE HOME DESCRIPTION
MANUFACTURER'S NAME M00E1. OR POP NAME SER IAL NUMBER OPERATOR 3D YR O� U TUBE Y O PURCO E PUACH/LS E p_RICE �p P ❑ NEW ` � USED SERE PUR SEO Pnl MOBILE 00 YOU HAVE LICENSE No. (IF APPUCABLE) WIOTH LENGTH WEIGHT COLO S
NO. AXLE.
HOME O BILL OF SALE 0 TITLE 1140 Fr. 10FT•
NO. OF ROOMS DUES MOB0.E HOME HAVE Y
• OWNER BATHS SOMAS. 0 SKIRTING 1 0 FIREPIJ.CE 0 PORCH 3F
0 AIR CONOITIONINO 0 WASHER ❑ PATIO SF
TOTAL ROOMS O OISHWASHER ❑ DRYER 0 CARPORT SF
PLEASE SIGNATURE OF MOBILE HOME OWNER /� �
SIGN HERE , : Ile. re on `I C DATE ueI ' t 14110
5-17.71-7K,7 »^'''''n 7 -" 1 " -c'c`+gy_"7'+c "—+wtt—"! ' Te x ''' rte" f, '' 7v cr _ •
.r ..,.,.u.s ....�.. ...:>v..:., ' � w . q , , F w.R.`�` i 3 c3 � � � Z s
OATE VIEWED OR INSPECTED
1. Total Fair Market Value $ •
ASSESSOR
2. Exempt Furnishings — $
SIGNATURE OF ASSESSOR
3. NET FAIR MARKET VALUE 5
(Subtract line 2 from lino 1)
yKfi ,R".�aaH7 9Yr ^t� .
K 4. ' j , h '. < { fi1 ' 1 ° �" t � b �d s � > 't : r i 2 t r ' t { r 2I',
...... v.. i ....:......... 5 .......:. n�... sa.. �.. .. ....` � " S�;� a�yPz�,v� y � <Z�•
4. Net Fair Market Value (from line 3 above) $ The first monthly fee
•
covers the month of
5. i'• Level of Local Assessme 1 , . X . .
(established for preceding Jan. 1 assessment)
(Ent.( month)
6. Value for Fee Computation (multiply line 4 by line 5) $
CLERK and is due on or bolo
7. Net Tax Rate (after state credits). the loth day of
(established for preceding January 1 assessmbnt) X
8. Annual Fee (multiply line 6 by line 7) 5
(Entv following motW
•
9. Gross Monthly Fee (divide line 8 by 12 months) 5 ^ i The monthly fee is du
. 10. Lottery Credit (if applicable) — $ on or before the 10th
•
. day of each month l
• 11. Net Monthly Fee (subtract line 10 from line 9) $ thereafter.
i
■
MOBILE HOME STATEMENT '
POSTED
INSTRUCTIONS
•
MOBILE HOME PARK OPERATOR (or owner Wand if mobile home subject to fee Is located outside ofpark):. Section A with mob
home owner. Submit in duplicate.to your local Assessor within 5 days of the arrival of each mobile home.
ASSESSOR: Complete Section 8. 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 i Rfi�ti p S ubmit form to local C
for computation of parking permit fee.
CLERK: Complete Section C. A 1 6 2010
1 A SSESSORS Or.-
> . : < , ,��« ' { ' CON ; ,'.
. �n T A �,K 2 k? t'Y .r , .; )516, " '+> r x 2 ` U A
TAXATION DISTRICT .. NAME OF MOBILE HOME OWNER � ��
City of Oshkosh ' LL1yIG `4-`r (C. It , �/
TO BE NAME OF PARK AD•RES OF PARK �.
Edison Estates -. i q <,
COMPLETED COUNTY ARRIVAL OATS ADDRESS OF UOBILE HOME
BY Winnebago ti/!IL 1 -
PARK MOBILE HOME DESCRIPTION
MANUFACTURER'S NAYS MOOEL OR POPULAR NAME SERIAL ER
OPERATOR ��i �C- - r r^}l
AND OF
YR OF U TURE Y OF PURCHASE PURCHASE PR co PURCHASED AS WHERE PUR SEO
I 01 0 5 ,l'..K O NEW OSZ , USED WC.-„
MOBILE CO YOU HAVE LICENSE N0. (IF APPUCABLE) WIDTH LENGTH WEIGHT COLOR NO. OF AxLES
HOME
0 BILL OF SALE 0 TITLE l(/� FT. - 10Fr.
NO. OF ROOMS DUES MOBILE HOME HAVE `f
OWNER BATHS 80RYS. 0 SKIRTING 1 0 FIREPLACE 0 PORCH 9F
0 AIR CONDITIONING ❑ WASHER ❑ PATIO SF
TOTAL ROOMS 0 OISHWASHER ❑ ORYER 0 CARPORT SF
PLEASE SIGNATURE OF MOBILE HOME OWNER OATE
p
SIGN HERE y . • 11. re on ..6ie . t41. l4(I0
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\�4+\
OATE VIEWEO OR INSPECTED
1. Total Fair Market Value $
ASSESSOR
2. Exempt Furnishings — $
SIGNATURE OF ASSESSOR
3. NET FAIR MARKET VALUE $
(Subtract line 2 from line 1)
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•
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'�' ;�`¢' :icy � iE �+ny4�yE �f�:. k , ° ., ....,: F ... ?,. .. .. .. ��� : ..... .. .. � C
4. Net Fair Market Value (from line 3 above) $ The first monthy fee
5. % Level of Local Assessment , • . X . . .
covers the month of
(established for preceding Jan. 1 assessment)
(Emit( month)
6. Value for Fee Computation (multiply line 4 by line 5) $
CLERK and is due on or befo
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) 5 . ; . The monthly fee is du
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.
• • • • ••• �• . Wfacronaln I.oarvnart of Rev