HomeMy WebLinkAboutJune 1, 2007 MOBILE HOME STATEMENT OF MONTHLY PARKING PERMIT FEE RECEIVED
JUN 12 2007
INSTRUCTIONS
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MOBILE HOME PARK OPERATOR (or owner of land if mobile home subject to fee is located outside of park): Cdrii il'eFe`S'eotiOlckw $ h'dmobile
home owner. Submit in duplicate to your local Assessor within 5 days of the arrival of each mobile home.
ASSESSOR: Complete Section B. 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 Clerk
for computation of parking permit fee.
CLERK: Complete Section C.
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TAXATION DISTRICT NAME OF MOBILE HOME r
City of Oshkosh Anne Hauch
TO BE NAME OF PARK ADDRESS OF PARK •
COMPLETED Patrician Village Virginian Street
COUNTY ARRIVAL DATE ADDRESS OF MOBILE HOME
BY Winnebago 6/1/07 1413 Indigo Drive
PARK MOBILE HOME DESCRIPTION
MANUFACTURER'S NAME MODEL OR POPULAR NAME SERIAL NUMBER
OPERATOR Wick Rollohome R71640
YR OF MANUFACTURE YR. OF PURCHASE PURCHASE PRICE PURCHASED AS WHERE PURCHASED
AND 1998 2007 S35,000.00 ❑ NEW ( USED Private
MOBILE DO YOU HAVE LICENSE NO. (IF APPLICABLE) WIDTH LENGTH WEIGHT COLOR NO. OF AXLES
HOME ❑ BILL OF SALE ❑ TITLE 16 FT' 72 FT
NO. OF ROOMS DOES MOBILE HOME HAVE
OWNER BATHS 1 BORMS. 2 g SKIRTING ❑ FIREPLACE ❑ PORCH SF
g AIR CONDITIONING 9 WASHER ❑ PAT SF
TOTAL ROOMS 5 IR DISHWASHER IR DRYER J ❑ CAR SF
PLEASE SIGNATU OF MOBILE HOME • A DA TE ,r Q 7
SIGN HERE ' ,l:e�•C% Z. •. co !
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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)
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4. Net Fair Market Value (from line 3 above) $ The first monthly fee •
covers the month of
5. % Level of Local Assessment X
(established for preceding Jan. 1 assessment)
(Enter month)
6. Value for Fee Computation (multiply line 4 by line 5) $
CLERK and is due on or before
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) $
The monthly fee is due
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.