HomeMy WebLinkAboutMarch 3, 2011 `rlSPt`*::'
MOBILE HOME STATEMENT OF MONTHLY PARKING PERMIT FEE RECEIVE
• MAR 1) 4 20 11
INSTRUCTIONS Asst
MOBILE HOME PARK OPERATOR (or owner of land If mobile home subject to fee Is located outside of park): Complete Secti n W1 Mf
h owner. Submit in duplicate to your local Assessor within 5 days of the arrival of each mobile ho e. p �
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. 3; j
7
TAXATION DISTRICT SCHOOL DISTRICT COUNTY NAME OF MOBILE H014 OWNER
TO BE NAME OF PARK ' " ,�( ( n
I \ � �� ADDRESS OF MOBILE HOME L
COMPLETED ADORE„.. • , P. u nn • . Poi
BY 11� - 1 ARRIVAL DATE OWNER PERMANENT ADDRESS _
'�1 4*-
PARK MOBILE HOME DESCRIPTION
MANUFACTURER'S MOOEL OR POPULAR NAME
OPERATOR f j, filC` SERIAL NUMBER
YR OF MANUFACTURE'
AND q • PURCHASE PURCHASED AS WHERE PURCHASE�
MOBILE 00 YOU HAVE `^ 0 NEW USED
UC N E NO. (IF APPLICABLE) WIDTH NGTH WEIGHT COLOR NO. OF AXLES
HOME 0 BILL OF SALE 0 TITLE {
NO. OF ROOMS DOES MOBILE HOME HAVE f
OWNER BATHS BORMS. 0 SKIRTING 0 FIREPLACE 0 PORCH SF
0 AIR CONOmONING 0 WASHER 0 PATIO SF
TOTAL ROOMS 0 DISHWASHER 0 DRYER
CARPORT SF
PLEASE SIGNATURE OF MOBILE HOME OWNER y'� .. �
SIG
DATE 1
oa L f o1 l \ t) 1
x n 'm5 ,F. .Y^`� . � {. . :z J y -, , 4 - p F fs 7 , � t, °�1 , 7 ,,, 77 , 7:77.7:77-71 , --,, , T , 7771 ,' :,
,,,{w,,: �4,. *; :uyr.<r °. *' '. 1. .v ;:,C ` . r1 >1 t ' 1, '�' , :: '.( '3 r R ',:n, „ a �� i i ; ','4'''q,0 X .,,I c ,s
1. Total Fair Market Value DATE VIEWED OR INSPECTED
ASSESSOR $
2. Exempt Furnishings — $
3. NET FAIR MARKET VALUE $ SIGNATURE OF ASSESSOR
(Subtract line 2 from line 1)
SFka '` °Fr+`�f Mr < ^zn r
� dit ;., , a 3 :> a vd G, ,, & t ti 9 ; , g a , , „ ,,. , h '' C )` fi
; - ` s . 3,. > sa t�`" ' " - � ' ti � s ` `4i $ , I f ' I` s� ' ' ' e a f
me .sy2h9 Pufs.c i S C " a� �•F
4. Net Fair Market Value (from line 3 above) $ The first monthly fee
5. % Level of Local Assessment X covers the month of
(established for preceding Jan. 1 assessment)
6. Value for Fee Computation (multiply line 4 by line 5) $ (Enter month)
CLERK
7. Net Tax Rate (after state credits) and is due on or before
(established for preceding January 1 assessment) X . the 10th day of
8. Annual Fee (multiply line 6 by line 7) S
•
9. Gross Monthly Fee (divide line 8 by 12 months) $ (Enter the following month)
Credit (if The monthly fee is due
10. Lottery ( applicable) — $ . on or before the 10th
•
11. Net Monthly Fee (subtract line 10 from line 9) Z day of each month
thereafter.
rwris (R. 0443)
Wisconsin Dent of Raw