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WVtNVI. <br /> MICHAEL L.MORGAN <br /> 13. SECRETARY <br /> -' ; ': K <br /> Division of Intergovernmental Relations <br /> ,..' . 101 East Wilson Street.l0"Floor <br /> =�• <br /> ...' Post Office Box 8944 <br /> W I S C 0 N S I N DEPARTMENT Of <br /> 3v <br /> f. Madison.WI 33708-8944 <br /> ADMINISTRATION Voice <br /> a'(608 i67-691769 <br /> DOA-7108(R02/2006) <br /> ss.59.72(3)&(5),and ss.59.43(2)(ag)I.&(e),Wis.Stats. Instructions: <br /> (� 1. Send all fees by the 16'"of each <br /> I Wisconsin Land Information Program month following the reporting month. <br /> PO Box 7869 2. Make check payable to: WVisconsin <br /> Department of Administration. <br /> Madison,WI 53707-7869 3. Include this form with your payment. <br /> 4. If you have questions please call <br /> (608)267-3369. <br /> Wisconsin Land Information Program <br /> County Recording Fee Submission <br /> Register of Deeds Name and Address: LIO Name and Address: Recording Period <br /> Jeanine Chell Jason Towne Dec. 1 2008 <br /> 7410 County Road K#103 7410 County Road K#120 <br /> Siren,WI 54872-9043 Siren,WI 54872-9043 Month I Year <br /> (NAME AND ADDRESS CORRECTION REQUESTED) <br /> Ai No <br /> 1. Does the County Land Information Office established on 6/19/1990 by the County Board per s.59.72(3), <br /> Wis. Stats., continue to perform the duties specified in s.59.72(3)(a-c),Wis.Stats.? X <br /> 2. Has County used$4 of each$5 fee collected under s.59.72(5),Wis.Stats.,to develop,implement,and <br /> maintain the countywide plan for land records modernization? X <br /> 3. WiIUHas County use/d$1 of each$5 fee collected under s. 59.72(5),Wis.Stats.,for the provision of <br /> land information on the Internet,including the county's land information records relating to housing? <br /> X <br /> Certification <br /> I,the designee or contact person for the County Land Information Office,certify under the penalty of perjury that the information <br /> prov" in questions 1-3 is true and correct to the best of my knowledge. <br /> a O� Z40 9 715-349-2599 <br /> 10 Signatur Da (mm! /ccyy) Phone Nurnber <br /> 4. Number of documents recorded and filed in the County Office of Register of Deeds under ss.59.43(2)(ag)1. 366 <br /> &(e),Wis. Stats. <br /> $ 732-00 <br /> 5. If questions 1-3 are all answered yes. multiply the amount on Line 4 by S2 and enter the total here... s <br /> 6. If questions 1,2 or 3 are answered no,multiply the amount on Line 4 by S7 and enter the total here : <br /> 7. County Check Number. .. In the amount of 732.00 <br /> Certification • <br /> I,the County Register of Deeds,certify under the penalty of perjury that the information provided in questions 4.7 is tue and correct to <br /> the of my knowledge. <br /> il1 <br /> R QgQiji14 - s. !)n7 715-349-2183 <br /> natu a Date(nxn/dd/ecyy) Phone Number <br />