HomeMy WebLinkAboutJune 28, 2010 MANUFACTURED & MOBILE HOME STATEMENT D ECEIVED
MONTHLY MUNICIPAL PERMIT FEE JUN 3 0 2010
INSTRUCTIONS A_s sscRs
CSnKZDS `'
MANUFACTURED & MOBILE HOME COMMUNITY OPERATOR (orownerofland if manufactured ormobile home subject
to fee 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 OWNE � —
_...... — .� —_.. ' —AL
TO BE NAME OF COMMUNITY
ADDRESS OFMANUFACTURE OR MOBILE HOME
COMPLETED S- C.) c � �� - ` 0 J /
COMMUNITr ADDRESS ARRIVAL DATE OWNER PERMANENT ADDRESS
BY '�
COMMUNITY I 03
MANUFACTURED OR MOBILE HOME DESCRIPTION'
OPERATOR MANUFACTURER'S NAME
MODEL OR POPULAR NAME SERIAL NUMBER
AND
MANUFAC-
iii Of MAN °'A TUR PURCHASE YEAR PURCHASE PRICE PURCHA ED AS WHEREPURCHASEO
TURED OR - •-- - — . _ L ._ �� � L~- 'l.l� ❑NEw ) JSE0
T
DO YOU HAVE NO. (IF APPLICABLE COLOR 7 O- F A -
MOBILE _. I BILL OF SALE TITLE I LICENSE ; WIDTH I. LENGTH WEIGHT I COLOR \ I NO O F AXLES
N O . OF ROOMS - — - — : - _._ ____ —•-
HOME f GOES THE UNIT HAVE t
i
BAT H$ BORMS _ 0 SKIRTING I
OWNER — [] AIR CONDITIONING 0 FIREPLACE
TOTAI.ROOMS ❑ WASHER (7 PAT$O ____,_- .- _- ,•.._..- . 5�
0 DISHWASHER 0 DRYER
.. .._. . ......_... __...._. ...._.._. _..__._. -.._. _ 0 CARPORT ...----_..
PLEASE
SI ATURE OF UNIT OWNER __....._. Sr
SIGN HERE , + I DArE
...s: a ■ 1 CO t
— ......._._.__.___ 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
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).... $ (Ewe, month)
7. Net Tax Rate (after state tax credit) and is due on or
(established for preceding January 1 assessment) X before the 101h day of
. l
$ _ (E girt(oI 9. Gross Monthly Fee (divide line 8 by 1 $ (Ener te lonown month) 10. Lottery Credit (if applicable) The monthly fee is
_ due on or before the
11. Nel Monthly Fee (subtract line 10 from ine 9) $ 10th day of each
PA-118 (R 1047) — month thereafter.
1Msconsm Department of Revenue