HomeMy WebLinkAboutNovember 2, 2006 �-, P.133/03
LTS ())2r 41' trI&S RECEIVED
MOBILE HOME STATEMENT OF MONTHLY PARKING PERMIT FEE
NOV - 3 200
INSTRUCTIONS ASSESsCs ;;FFICE
OSHKOSH, WISCONSIN
MOBILE HOME PARK OPERATOR (or owner of land if mobile home subject to fee is located outside of park): Complete
Section A with mobile home owner. Submit in duplicate to your local Assessor within 5 days ofthe 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.
SECTION A :. :
TAXATION DISTRICT SCHOOL DISTRICT COUNTY NAME OF MOBILE HOME OWNER
NAME OF PARK ,j . 0 DRESS OF MOBE HOME
TO BE .� ,Es VUi L. . 3 7'( ( G - lam/ lr•
COMPLETED PARK ADDRESS ARRIVAL DATE OWNER PERMANENT ADDRESS
BY r l / (1( -z. ( 3
PARK MOBILE HOME DESCRIPTION
OPERATOR MANUFACTURER'S NAME MODEL OR POPULAR NAME SERIAL NUMBER pC�
AND &H S93
Y OF NU TURF PU CHASE YEAR PURCHASE PRICE PURCHASED AS WHERE PURCHASED
MOBILE _12-7--/ C � I( 11 _ ,L.> )� ` ❑ NEW �usaD �T
HOME DO YOU HAVE LICENSE NO. (IF APPLICABLE) WIOT LENGTH WEIGHT COLOR NO. OFAXLES
OWNER BILL OF SA r]TITLE 1 / FT7 ) F T.
NO. OF ROOMS DOES MOBILE HOME HAVE V —'
BATHS BDRMS ❑ SKIRTING ❑ FIREPLACE ❑PORCH
❑ AIR CONDITIONING ❑ WASHER ❑ PATIO $F
TOTAL ROOMS ❑ DISHWASHER ❑ DRYER 0 CARPORT SP
PLEASE SIGNATURE OF MOBILE MOMS OWNER T n �+v
SIGN HERE' �' C U/I lJ�� . C il . Q i r7 . p 1 / A o
\ \\ 1111 UP / 6 • __ _,_ • SECTION B — VALUATION .. ,
DATE VIEWED OR INSPECTED
ASSESSOR 1- Total Fair Market Value $
2. Exempt Furnishings — $
3. NET FAIR MARKET VALUE $ SIGNATURE OF ASSESSOR
(Subtract line 2 from line 1) - "'
• SECTION C — COMPUTATION OF PARKING PERMIT FEE
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 mulls l ine 4 by l ine 5) (Enter month)
l
P (multiply Y ).... $
CLERK 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) $ (Enror the following mooch)
10. Lottery Credit (if applicable) The monthly fee is
— due on or before the
11. Net Monthly Fee (subtract line 10 from line 9) $ 10th day of each
month thereafter.
PA-1111 (R. 12-04)
Wisconsin Dcpartrnonl of Revenue
Tr1TA1 P _ PM