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RECORDING FEE SUBMISSION ! . '3 �• f <br /> � •illlt,ros. 1 <br /> NSTRUCTIONS: 1. Send all fees by the 16th of each month. ��` �•�` <br /> 2. Checks should be made payable to: WI DEPARTMENT OF ADMINISTRATION <br /> 3. Include this form with your payment. . <br /> 4. tf you have questions please call 608/267-2707. - _ <br /> r <br /> WI Land Information Program <br /> P.O. Box 7869 <br /> Madison, WI 53707-7869 <br /> • <br /> SECTION A <br /> )unty Name Reporting Period <br /> BURNETT •COUNTY November, 1991 <br /> ailing Address <br /> • 7410 - CnnNTY RflAn K , #103 • <br /> SIREN, WI 54872 <br /> SECTION.I3 <br /> YES NO <br /> Has the County Board established a Land Information Office Pursuant Ws.Stats.Sec.59.88(3)? X <br /> If so,date established? June 21, 1990 <br /> Has the county used the fees collected under Wis.Stats.Sec.59.88(5)exclusively for the development, <br /> implementation,and maintenance of the county-wide plan for land records modernization? X <br /> RTIFICATION <br /> e designee or contact person for the Land Information Office,certify under the penalty of perjury that the <br /> rmation provided in Section B is true and correct to the best of my knowledge. <br /> • A)/AA/ / 715-349-2599 <br /> iature Date Phone No. • <br /> SECTION C <br /> Number of documents recorded and filed in the Office of Register of Deeds under Wis.Stats.Sec.59.57(1)(a)and(6a)? 412 <br /> If•you have answered yes to both questions in Section B,multiply the amount on Line 3 by$2.00 and enter the total here: $ 824 <br /> tf you have answered no to either questions in Section B,multiply the amount on Line 3 by$4.00 and enter the total here: $ <br /> Amount submitted: $ 824 .00 <br /> rIFICATION <br /> Register of Deeds,certify under the penalty of perjury that the information provided in Section C is true and correct to the best of my knowledge. <br /> 1 —//,57 /7/ <br /> lure 715-349-2813 <br /> Date Phone No. <br />