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WISCONSIN LAND INFORMATION PROGRAM ! 'tt;l";,;.?• • RECORDING FEE SUBMISSION Q .INSTRUCTIONS: 1. Send all fees by the 16th of each month. '•r=� • 2. Checks should be made payable to: WI DEPARTMENT OF ADMINISTRATION 3. Include this form with your payment. 4. If you have questions please call 608/267-2707. P WI Land Information Program P.O. Box 7869 Madison, WI 53707-7869 •J SECTION A County Name Reporting Period RhtrnPt-t- ro int-y February 1998 Mailing Address 741 fl rot inty Road K. #103 Siren, WI 54872 SECTION B YES NO 1. Has the County Board established a Land Information Office Pursuant Wis.Stats.Sec.59.88(3)? If so,date established? June 21, 1990 2. Has the county used the fees collected under Wis.Stats.Sec.59.88(5)exclusively for the development, implementation,and maintenance of the county-wide plan for land records modernization? X CERTIFICATION I,the designee o:contact person for the Land Information Office,certify under the penalty of perjury that the information provided in Section B is true and correct to the best of my knowledge. � 9d Signature 715-349-2599 D ,e Phone No. SECTION C 3. Number of documents recorded and filed in the Office of Register of Deeds under Wis.Stats.Sec.59.57(1)(a)and(6a)? 428 4. If you have answered yes to both questions in Section B,multiply the amount on Une 3 by$2.00 and enter the total here: • $ 856.00 • 5. If you have answered no to either questions in Section B,multiply the amount on Une 3 by$4.00 and enter the total here: $ 6. Amount submitted: $ 856.00 CERTIFICATION I.the Register of Ceeds,certify under the penalty of perjury that the information provided in Section C is true and correct to the best of my knowledge. O i March 2, 1998 • 715=-349 2183 Signature Date Phone No.