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RECORDING FEE SUBMISSION `;1"I <br /> INSTRUCTIONS^ i. Send all foes 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 606/267-2707. • <br /> P <br /> WI Land Information Program <br /> P.O. Box 7869 ,, <br /> Madison, WI 53707-7869 • •• <br /> SECTION A <br /> County Name Reporting Period <br /> RtirnP1-t• rniinty • ' /• —q / <br /> Mailing Address <br /> 741n re nnty Road K, #1.03 <br /> Siren, WI 54872 <br /> SECTION B <br /> • <br /> YES NO <br /> 1. Has the County Board established a Land Information Office Pursuant Wis.Stats.Sec.59.88(3)? • <br /> ft so,date established? June 21, 1990 - <br /> • <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 countywide 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 /> ) . 37a//Q47 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)? Sq <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: • $ <br /> 5. ft 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 /> 5. Amount submitted: $ ,� <br /> CERTIFICATION <br /> 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. <br /> Signature 715=349 218 <br /> Date Phone No. <br />