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• WISCONSIN LAND INFORMATION PROGRAM ,',. l‘-. <br /> RECORDING FEE SUBMISSION :4t } .! <br /> -„r=� <br /> INSTRUCTIONS: 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. If you have questions please call 608/267-2707. <br /> T <br /> WI Land Information Program <br /> P.O. Box 7869 <br /> Madison, WI 53707-7869 <br /> • <br /> SECTION A <br /> County Name Reporting Period <br /> RurnPtt rcmnty • May, 1998 <br /> Mailing Address <br /> 741 fl ("minty Road K, #103 <br /> Siren, WI 54872 <br /> SECTION B <br /> YES NO <br /> 1. Has the County Board established a Land Information Office Pursuant Wis.Stats.Sec.59.88(3)? —X_ <br /> ll so,date established? June 21, 1990 <br /> 2. 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? <br /> CERTIFICATION <br /> I,the designee o:contact person for the Land Information Office,certify under the penalty of perjury that the <br /> information provided in Section B is true and correct to the best of my knowledge. <br /> 715-349-2599 <br /> Signature Date Phone No. <br /> SECTION C <br /> 3. Number of documents recorded and filed in the Office of Register of Deeds under Wis.Stats.Sec.59.57(1)(a)and(6a)? 674 <br /> 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: • $ 1,348.00 • <br /> 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: $ <br /> 6. Amount submitted: <br /> 3 1,348.00 <br /> CERTIFICATION <br /> I.the Register of seeds,certify under the penalty of perjury that the Information provided in Section C Is true and correct to the best of my knowledge. <br /> /9Y - <br /> ?15 349 2183 <br /> Signature • Date Phone No. <br />