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HomeMy WebLinkAboutApril 12, 2006 MOBILE HOME STATEMENT OF MONTHLY PARKING PERMIT FEE RECEIVED • APR 13 2006 INSTRUCTIONS ASSESSORS OFFICE MOBILE HOME PARK OPERATOR (or owner of land If mobile home subject to fee Is located outside of perk): Complete Se A S wi th mobile 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 0 included in that figure. Submit form to local Clerk for computation of parking permit fee. CLERK: Complete Section C. TAXATION DISTRICT SCHOOL DISTRICT E OF MOBILE HOME OWNER £s;x�s c . COMM UNTY TO BE NAME OF PARK iLe ;. `^• -tly_____% � r` j� � i QUO � ADDRESS OF MOBILE HOME - COMPLETED ,. ! Gt a G . unn 1) -e. uo PcI , PARK ADDRESS ARRIV DATE OWNER PERMANENT ADDRESS J BY 1- 10 0 ' PAR V� . S i 010 .4=t- 3-1 K tiuNUFACruRER NAME MOBILE HOME DESCRIPTION OPERATOR be-i MODEL OR POPULAR NAME SERIAL NUMBER ( +y CoL 18 AND YR OF MANUFACTUR PURCHASE YR PURCHASE PRICE PURCHASED AS WHE E URCH 1983 24_1.10 Z©a ❑ NEW)2*-6"SED it MOBILE 00 YOU HAVE IJCENSE NO. (IF APPLICABLE) i WIDTH LENGTH WEIGHT COLOR 0 BILL OF SALE O TITLE l NO. OF AXLES HOME {t.� Fr. 70 Ft I NO. OF ROOMS DOES MOBILE HOME HAVE OWNER BATHS BDRMS. 0 SKIRTING ❑ FIREPLACE 0 PORCH SF 0 AIR CONDmONING ❑ WASHER ❑ PATIO TOTAL ROOMS ❑ DISHWASHER SF ❑DRYER ❑CARPORT SF PLEASE SIGNATURE OF MOBILE HOME OWNE SIGN HERE > ' r ISM f on ^ DATE HI iz 1'0(. h { r n' - , R ° s , 3 z; .,, 5' , :, i y' i' z e .‘m-7,7,77 .�� „' '.�,'` ,' �",Z. % r s. ',.. ', ;',L `. :, z : �^s , ` ?�. a ,, - ,. 'z .. ?.Q � `t� Y . . : xw., P;,z3 , ;.. x n 7 .' F: s .wo`eaiS.r�i'w x....e 1. Total Fair Market Value $ DATE VIEWED OR INSPECTED ASSESSOR 2. Exempt Furnishings – $ 3. NET FAIR MARKET VALUE $ SIGNATURE oFASSESSOR (Subtract line 2 from line 1) � b � mr � , ¢T :� £'°CSoF�3£: •, z ,� • . � ~ s� a M ° < ..‘,,s, a ` P " " S.t,n Z '" ° <. E s wI q { . 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) 9. Gross Monthly Fee (divide line 8 by 12 months) $ (Enter the following month) 10. Lottery Credit (if applicable) The monthly fee is due S...—..... on or before the 10th 11. Net Monthly Fee (subtract line 10 from line 9) $ day of each month thereafter. PA- 111(R. 0043) 0 Wisconsin Department of Rewraps