HomeMy WebLinkAboutApril 14, 2010 •
MOBILE HOME STATEMENT ''°
POSTED
INSTRUCTIONS
MOBILE HOME PARK OPERATOR (or owner olland if mobile home subject to lee is located outside olpark):• Section' A with mob
home owner. Submit in duplicate.to your focal 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 in tit clefv form to local C
for computation of parking permit fee.
CLERK: Complete Section C. APR 1 6 2010
ASSESSORS OF
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TAXATION DISTRICT •• 1 NAUE OF MOBILE HOME OWNER
City of Oshkosh li �nY r .
(, r
TO BE NAME OF PARK ADDRESS OF PARK 18��. r { r
Edison Estates RIBS Cole I.L) . 11
COMPLETED COUNTY ARRIVAL DATE AOORESS OF MOBILE HOVE
BY Winnebago �j j ° I 4
PARK l MOBILE HOME DESCRIPTION
MANUFACTURER'S NAME MODEL OR POPULAR NAM SERIAL NUMBER
OPERATOR L{'J --k Ci Li Co Le I •
AND YR O I C-I S3 RE �0 10 PURCHASE 1$ CQ _ PURCHASED ❑ NEW USED ERE PURCHAS ri+ 9C
MOBILE 00 YOU HAVE LICENSE NO. (IF APPUCABLE) WIOTH il.E I WEIGHT COLOR NO. OF AXLE:
•
HOME ❑ BILL OF SALE ❑ TITLE FT. FT.
NO. OF ROOMS DOES MOBILE HOME HAVE
OWNER BATHS BOWS. ❑ SKIRTING ❑ FIREPLACE ❑ PORCH 9F
❑ AIR CONOITIOHING ❑ WASHER ❑ PATIO SF
TOTAL ROOMS ❑ DISHWASHER ❑ ORYER ❑ CARPORT SF
PLEASE SIGNATURE OF MOBILE HOMEOWNER /� .411 SIGN HERE .. 10 rt on ` DATE 1 to t„...,.,,,,, -
,„ .. t 5 �..,,, . .� ?tit y t [ ;*- t t - 2?, C ; � y ?N ��.Sf ... :. � :: .. ^���� ,.. �'r. �y;`a����2+2Y��r�.a'a�' -. �46t•Nt",t,„
OATS VIEWED 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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� . 22 t a: � ., � t0t ,, e �s Fly Kl . Ci �4!T , , . Y � z
4. Net Fair Market Value (from line 3 above) $ The first monthly fee
• covers the month of
5. y. Level of Local Assessment X
(established for preceding Jan. 1 assessment)
(Enter month)
CLERIC 6. Value for Fee Computation (multiply line 4 by line 5) S
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 montr
9. Gross Monthly Fee (divide line 8 by 12 months) $ '• 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.
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