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RECORDING FEE SUBMISSION '` <br /> t `moi <br /> INSTRUCTIONS: 1. Send all fess by the 18th of each month. • <br /> 2. Checks should be made payable to: WI DEPARTMENT OF ADMINISTRATION <br /> • 3. Include this forth with your payment. <br /> 4. If you have questions please call 50W267-2707. • <br /> T <br /> --� <br /> WI Land Information Program <br /> P.O. Box 7869 • <br /> Madison, Wi 53707-7869 <br /> • <br /> SECTION A <br /> County Name <br /> T n -nrz -f rminty Reporting Period <br /> Mailing Address <br /> 7d1 fl ['_aunty Road K. *103 <br /> Siren, WI 54872 <br /> SECTION B <br /> 1. Has the County Board established a Land Information Office Pursuant Wis.Stats.Sec.59.88(3)? YES NO <br /> If so,date established? June 21, 1990 --X— <br /> 2. Has the county used the fees collected under'Ms.Stats.Sea 59.88(5)exclusively for the development, <br /> implementation,and maintenance of the oounty-wide plan for land records modernization? <br /> — — <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 /> gnature y G ���/ 715-349-2599 <br /> to Phone No. <br /> SECTION C <br /> I. Number of documents recorded and filed In the Office of Register of Deeds under Wis.Stats.Sec.59.57(1)(a)and(6a)? 597 <br /> I. If you have answered yes to both questions in Section B,multiply the amount on Una 3 by$2.00 and enter the total here: • $ 1,194.00 <br /> 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: $ <br /> I. Amount submitted: <br /> • $ 1,194.00 <br /> :ERTIFICATION <br /> the Register of Coeds.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 /> • <br /> ciet7111 ,' - / <br /> rigrtatwe 715 4 g—21 A <br /> Date Phone No. <br />