HomeMy WebLinkAboutJune 28, 2010 •
RECEIVED
MANUFACTURED & MOBILE HOME STATEMENT OF
MONTHLY MUNICIPAL PERMIT FEE 3 O 2010
A ... , -, , -.---,
INSTRUCTIONS
C)Shr(C W :. ;IN
MANUFACTURED & MOBILE HOME COMMUNITY OPERATOR (or ownero( land if manufactured or mobile home subject
to fee is located outside 0 !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 OWNER -
j 7 i 1 ,
CMM T
UNIY — _
TO BE ADDRESS OFMANUFACTURE� MOBILE NAME OF O
COMPLETED -L 4S.On ._� - 3-- , 4 COMMUADDRESS ARRIV DATE OWNER PERMANENT ADDRESS
BY -
COMMUNITY 1 v �� IA
MANUFACTURED OR MOBILE HOME DESCRIPTION
OPERATOR MANUFACTURER'S • ME
AND MODEL OR POPULAR NAME • / SERIAL NUM BER
MANUFAC- YROf MANUF CTURE PURCHASE YEAR PURCHASE PRICE --- - -. .. _.
— --
PURCHASED AS WH E PURCHASED
TURED OR - - - • � - -_. L.a . 1.�1 ❑ NEW LilySE ED YOU HA � VE I LICENSE NO. (I APPLICABLE) yyIDTH LENGTH EIGHT < -
MOBILE „ j BILL OF SALE :) TITLE I COLOR ,\ ��0. OF AxLES
NO OF ROOMS ___ FL -1LrT I
HOME �ooes THE — UNIT NAVE — —� --- ••t .._.._.. _•._ i...
BATHS- BORMS _ 0 SKIRTING
OWNER
— 0 AIR CONDITIONING L FIREPLACE Li PORCH Sr
`.._I WASHER
TOTAL ROOMS (7 PATIO
0 DISHWASHER - - • -• - - -- SF
_ _ __ UNIT OWNER
Li DRYER
jJ CARPORT
PLEASE SI TURE OF Sr
•
SIGN HERE / I j DATE
t ( - -L(
SECTION B - VALUATION •
DATE 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)
_ SECTION C - COMPUTATION OF MUNICIPAL PERMIT FEE
4. Net Fair Market Value (from line 3 above)
S----------...------ co f monthly foe
5. % Level of Local Assessment covers the month of
(established for preceding Jan. 1 assessment) X " -- - - --
6. Value for Fee Computation (multiply line 4 by line 5) .... $ _
(Enter month)
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 by line 7) - -
_� - - - ---
9. Gross Monthly Fee (divide line 8 by 12 months) -i
(Enter t rotlowmg mo nth)
$
10. Lottery Credit (if applicable)
— — The monthly fee is
11. Net Monthly Fee (subtract line 10 from line 9) $ - ••--• --- due on or before the
10th day of each
P A rletR Io•OT) month thereafter
ft :conLn Department or Revenue