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WISCONSIN LAND INFORMATION PROGRAM *r, <br /> RECORDING FEE SUBMISSION <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 /> WI Land Information Program <br /> P.O. Box 7869 <br /> Madison, WI 53707-7869 • <br /> SECTION A <br /> County Name Reporting Period <br /> 111irnPt1- ['minty March, 1999. <br /> Mailing Address <br /> 741 n Cniinty 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 /> if 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? X <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 /> - -le• d3/51/qq' 715-349-2599 <br /> Signature Idate Phone No. <br /> SECTION C <br /> • <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)? 699 <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: • $ 1,398.00 <br /> 5. If you have answered no to either questions in Section B,multiply the amount on Une 3 by 54.00 and enter the total here: $ <br /> 6. Amount submitted: $ 1,398.00 <br /> • <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 /> • <br /> March 31; 1999 715=�49 218 <br /> Signature Date Phone No. <br /> 1 .. • <br />