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rc t JUtbI155IUIV ; ;•",qtly: - <br /> NSTRUCTIONS: 1. Send all fees by the 16th of each month. » " = I'• <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 /> • <br /> WI Land Information Program <br /> P.O. Box 7869 <br /> Madison, WI 53707-7869 <br /> • <br /> SECTION A • <br /> aunty Name I Reporting Period <br /> BURNETT •COUNTY October 1991 <br /> ailing Address <br /> • <br /> 7 410 — rntTNTv ROAD .K . 4103 <br /> • SIREN, WI 54872 <br /> SECTION.B <br /> YES NO <br /> Has the County Board established a Land Information Office Pursuant Wis.Stats.Sec.59.88(3)? <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 /> / <br /> <��''`� <br /> c _ • i/// / 715-349-2599 <br /> • <br /> iature bate 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)? 497 • <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: $ 994 - <br /> If 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 /> Aount submitted: $ 994 . 00 <br /> m <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 <br /> 715-349-2813 <br /> ,ture Date Phone No. <br />