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• WISCONSIN LAND INFORMATION PROGRAM r" r&fl=%,y ,. RECORDING FEE SUBMISSION • f _ �all0 .INSTRUCTIONS: 1. Send all fees by the 16th of each month. fir= • 2. Checks should be made payable to: Wl DEPARTMENT OF ADMINISTRATION 3. Include this form with your payment. 4. if you have questions please call 608/267-2707. • WI Land Information Program P.O. Box 7869 Madison, WI 53707-7869 SECTION A County Name Reporting Period Rvrnptt Cif-mintyMarch 1998 Mailing Address 741 n C'_nnnty Rokd 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. 4 /7 715-349-2599 Sign, ure Date 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)? 590 4. H you have answered yes to both questions in Section B,multiply the amount on Una 3 by$2.00 and enter the total here: • $ 1.180.00 5. If you have answered no to either questions In Section B,multiply the amount on Una 3 by$4.00 and enter the total here: $ 6. Amount submitted: $ 1,180.00 CERTIFICATION I,the Register of Clods,certify under the penalty of perjury that the information provided in Section C is true and correct to the best of my knowledge. • 1 �� p April 1, 1998 — 715 3 4 9-2 1 8 3 Signature Date Phone No. I .