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JIM DOYLE <br /> �s.,� GOVERNOR <br /> N, STEPHEN E.BABLITCH <br /> SECRETARY <br /> Division of Intergovernmental Relations <br /> 101 East Wilson Street,10th Floor <br /> WISCONSIN DEPARTMENT OF Padisonost WI 944 <br /> Madison.WI 53708-8944 <br /> ADMINISTRATION Voice(608)266-0288 <br /> Fax(608)267-6917 <br /> TTY(608)267-9629 <br /> DOA-7108(R09/2001) <br /> ss.59.72(3)&(5).and ss.59.43(2)(ag)1.&(e),Wis.Stats <br /> Instructions: <br /> I- 1. Send all fees by the 16"'of each <br /> Wisconsin Land Information Program month following the reporting month. <br /> PO Box 7869 2. Make check payable to: Wisconsin <br /> Madison, WI 53707-7869 Department of Administration. <br /> 3. Include this form with your payment. <br /> I 4. If you have questions please call <br /> (608)267-7982. ' <br /> Wisconsin Land Information Program <br /> Burnett County Recording Fee Submission <br /> Register of Deeds Name and Address: LIO Name and Address: Recording Period <br /> Jeanine Chell Kathy Swingle Jason Towne <br /> Feb. / 2008 <br /> Register of Deeds Land Information Office <br /> 7410 County Rd K#103 7410 County Rd K#120 Month / Year <br /> Siren, WI 54872-9043. Siren,WI 54872 <br /> (NAME AND ADDRESS CORRECTION REQUESTED) <br /> Yes No <br /> 1. Does the Burnett County Land Information Office established on 6/19/1990 by the County Board per s. <br /> 59.72(3),Wis. Stats.,continue to perform the duties specified in s. 59.72(3)(a-c),Wis. Stats.? X <br /> 2. Has Burnett County used$4 of each$5 fee collected under s.59.72(5),Ws.Stats.,to develop, <br /> implement,and maintain the countywide plan for land records modernization? X <br /> 3. HasWll Burnett County used/use$1 of each$5 fee collected under s. 59.72(5),Wis. Stats.,to develop <br /> and maintain a computerized indexing of the county's land information records relating to housing, <br /> including the housing element of the County's land use plan under s.66.1001(2)(b),Stats.,in a manner <br /> that would allow for greater public access via the Internet? X <br /> Certification <br /> I,the designee or contact person for the Burnett County Land Information Office,certify under the penalty of perjury that the <br /> information provided in questions 1-3 is true and correct to the best of my knowledg . <br /> v 715-349-2599 <br /> L d� 204 <br /> ir-...-1.-4- <br /> rSignature Date(mm d/ccyy) Phone Number <br /> 4. Number of documents recorded and filed in the Burnett County Office of Register of Deeds under ss. 446 <br /> 59.43(2)(ag)1.&(e),Wis. Stats. <br /> 5. If auestions 1-3 are all answered yes.multiply the amount on Line 4 by$2 and enter the total here... $ 892.00 <br /> 6. If questions 1,2 or 3 are answered no,multiply the amount on Line 4 by$7 and enter the total here $ <br /> 7. County Check Number: In the amount of: $ 892.00 <br /> Certification <br /> I,the Burnett County Register of Deeds,certify under the penalty of perjury that the information provided in questions 4-7 is true and <br /> correct to the best of my knowledge. <br /> cO �� 3.3 -c g 715-349-2183 <br /> RSignature Date(mm/dd/ccyy) Phone Number <br />