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JIM DOYLE <br /> , V GOVERNOR <br /> -. STEPHEN E.BABLITCH <br /> . SECRETARY <br /> i.1 Division of Intergovernmental Relations <br /> 101 East Wilson Street,10` Floor <br /> WISCONSIN DEPARTMENT Of Post Division <br /> (x8944 <br /> ADMINISTRATION Madison.WI 530 8-8944 <br /> Voice(608)8)266-0288 <br /> Fax(608)267-6917 <br /> TTY(608)267-9629 <br /> DOA-7108(R09/200I) <br /> ss.59.72(3)&(5).and ss.59.43(2)(ag)1.&(e),Wis.Stats <br /> Instructions: <br /> 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 /> 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: L1O Name and Address: Recording Period <br /> Jeanine Chell Kathy-Swingle Jason Towne August / 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),Ws. Stats.? X <br /> 2. Has Burnett County used$4 of each$5 fee collected under s. 59.72(5),Wis.Stats.,to develop, <br /> implement,and maintain the countywide plan for land records modernization? X <br /> 3. Has/Will 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 /> inform . provided in questions 1-3 is true and correct to the best of my knowledge. <br /> _...(-7,-----.----- <br /> 09/0?/ZOO.? 715-349-2599 <br /> 0 Signature Date(mm/dd/ccyy) Phone Number <br /> 4. Number of documents recorded and filed in the Burnett County Office of Register of Deeds under ss. <br /> 59.43(2)(ag)1.&(e),Ws. Stats. 401 <br /> 5. If auestions 1-3 are all answered yes. multiply the amount on Line 4 by$2 and enter the total here... $ 802.00 <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: $ 802.00 <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 /> correcta best of my knowledge. <br /> )h <br /> PiZiaLzkP (hj2j 9 -a - 715-349-2183 <br /> RO Signature Date(mm/dd/ccyy) Phone Number <br />