HomeMy WebLinkAboutMarch 30, 2011 1 NS 0K.s
RECEIVED
MOBILE HOME STATEMENT OF MONTHLY PARKING PERMIT FEE p
-APR 01 2011
INSTRUCTIONS .:::::::::CRS OFFICE
"S'- S- WISCONSIN
MOBILE HOME PARK OPERATOR (or owner of land if mobile home subject to fee is located outside of park): Complete Section A witb
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 Homo . - .. 74•7A \ • y r � r
Worksheet). NOTE: Exempt furnishings must be subtracted from the fair market value if included in that figure. Su fl)-- c •+ . <<. ., .'. i J ' a%
for computation of parking permit fee. , .. ..• op,..
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• CLERK: Complete Section C. i�� > r- f
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TAXATION DISTRICT NAME OF MOBILE HOME OWNER
c4_ of OSl/ll.. h i%k \ �U �� etrcieta A ry
TO BE NAME OF PAR y A DbRESS F P RK
COMPLETED COUNTY ARRIVAL DATE ADDRESS OF MOBILE HOME
BY lid 1 1\b1Q v Lk- \k < - it)
MOBILE HOME DESCRIPTION
PARK MANUF TURER•S NAME MODEL OR POPULAR NAME I SERIAL NUMBER
OPERATOR 1?A \a-r \ t‘ as5i6S
YR OF MANUFACTURE YR. OF PURCHASE PURCHASE PRICE PURCHASED AS WHERE PURCHASE-14 y
AND I a I si () 1 t / 16Q) O NEW C4JSED T " Ne
MOBILE DO YOU HAVE LICENSE NO. (IF APPLICABLE) LENGTH WEIGHT COLOR NO. OF AXLES
0 BILL OF SALE 0 TITLE ( (WIDTH
1 (CPT. % FT. I I
HOME NO. OF ROOMS DOES MOBILE HOME HAVE
OWNER BATHS BDRMS. 0 SKIRTING 0 FIREPLACE 0 PORCH 8F
❑ AIR CONDITIONING ❑ WASHER 0 PATIO SF
TOTAL ROOMS 0 DISHWASHER 0 DRYER 0 CARPORT SF
PLEASE SIGNATURE 0 . OBILE HOME OWNER 1 DATE 3-36---k `
SIGN HERE 1 . i ■ •
% o-. -:.. :. ".V, d.: +' J ° T x \: t'}. hOty S xks a• ' ^w'• .\$''c'F?M 4 An,. t '' r k ' 5.
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x tn:�7 � .. .
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)
• p Fro-' •
• f, > :F " : , ..,• r- :. t , " O • t!;,C} t t}t „°,t �. ;.t: :..: ....... .
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.
•
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