HomeMy WebLinkAboutNovember 8, 2006 f
MOBILE HOME STATEME T F MONTHLY PARKING PERMIT FEE
INSTRUCTIONS
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 of the arrival of each mobile home.
ASSESSOR: Complete Section B. Determine the fair market value of the mobile home. (Use PA- 11_7„49Ii ,Nome Valuation
Worksheet). NOTE: Exempt furnishings must be subtracted from the fair market value if includes "in tfigt g re. Submit form
to local Clerk for computation of parking permit fee.
CLERK: Complete Section C.
NOV 13 2003
ASS^ 95�Ka OFF
OSHKOSH. WISCOh
SECTION A
TAXATION DISTRICT SCHOOL DISTRICT COUNTY NAME OF MOBILE HOME OWNER
.-hectii Di=r) , .
TO BE- d pr
NAME OF PARK (_ �. �l
DRESS / OF MOBILE H
COMPLETED PARK ADDRESS ARRIVAL DATE O PERM ADDR / SS
BY 1110/0L0 37 / 7OA/ vno 1 kS
PARK MOBILE HOME DESCRIPTION
OPERATOR MANUFF■CTURER'S NAME MODEL OR POPULAR NAME SERIAL NUMBER
AND L C 0 bL a Vas l
YR OF MANUFACTURE PUR HASE YEAR PURCHASE PRICE PURCHAS D AS WHERE PURCHASED
MOBILE " 2 b „ r
.7 �ll�w ❑NEW U ED
HOME D d YOU HAVE LICENSE NO. (IF APPLICABLE) WIDTH ^E TH WEIGHT COL NO. OF AXLES
OWNER ❑ BILL OF SALE ❑TITLE
is FT. FT.
NO. OF ROOMS DOES MOBILE HOME HAVE
BATHS BDRMS ❑ SKIRTING ❑ FIREPLACE ❑ PORCH SF
❑ AIR CONDITIONING ❑ WASHER ❑ PATIO SF
TOTAL ROOMS ❑ DISHWASHER ❑ DRYER ❑ CARPORT SF
PLEASE SIGNATURE OF MOBILE HOME OWNER / 1 DATE / 1 ,..
SIGN HERE S i Q 4 (' l t l ij , if /6 (r,
SECTION B - VALUATION
DATE VIEWED OR INSPECTED
ASSESSOR 1. Total Fair Market Value $ /ii / _Q C
2. Exempt Furnishings — $
E OF A
3. NET FAIR MARKET VALUE $ SIGNATURE ESSOR
� � /Y �
(Subtract line 2 from line 1) / el , daal
SECTION C - COMPUTATION OF PARKING PERMIT FEE
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) .... $
and is due on or
CLERK
7. Net Tax Rate (after state tax credit) before 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
10. Lottery Credit (if applicable) —$ due on or before the
10th day of each
11. Net Monthly Fee (subtract line 10 from line 9) $ month thereafter.
PA -118 (R. 12 -04) Wisconsin Department of Revenue