Laserfiche WebLink
y .,uY•vv■LAW. <br /> GOVERNOR <br /> w `"r. : 11'. MARC J.MAROTTA <br /> = ' • <br /> • SECRETARY <br /> n <br /> Office of Land Information Services <br /> WISCONSIN DEPARTMENT OF <br /> i <br /> '` ADMINISTRATION Madiso17 Soutnh,FWI airchid53703Strect, <br /> Voice( 267-2707 <br /> Fax(608)266-5519 <br /> olisfu:doa.state.wi.us <br /> DOA-7108(R092001) hup://www.doa.state.wi.us'ohs <br /> ss.59.72(3)&(5),and ss.59.43(2)(ag)I.&(e),Wis.Stats <br /> Instructions: <br /> 1. Send all fees by the 16"'of each <br /> Wisconsin Land Information Program month following the reporting month. <br /> PO Box 7869 2. Make check payable to: Wisconsin <br /> Madison,WI 53707-7869 Department of Administration. <br /> 3. Include this form with your payment. <br /> 4. If you have questions please call <br /> (608)267-2707. <br /> Wisconsin Land Information Program <br /> Burnett County Recording Fee Submission <br /> Register of Deeds Name and Address: LIO Name and Address: Recording Period . <br /> Jeanine Chell Kathy Swingle May / 2004 <br /> Register of Deeds Land Information Office <br /> 7410 Cty Rd K#103 7410 County Rd K#120 Month / Year <br /> Siren,WI 54872-9043 Siren,WI 54872 <br /> (NAME AND ADDRESS CORRECTION REQUESTED) <br /> Yes No <br /> 1. Does the Burnett County Land Information Office established on 06/21/1990 by the County Board per s. <br /> 59.72(3),Wis.Stats.,continue to perform the duties specified in s.59.72(3)(a-c),Wis.Stats.? X <br /> 2. Has Burnett County used$4 of each$5 fee collected under s.59.72(5),Wis.Stats.,to develop, <br /> implement,and maintain the countywide plan for land records modernization? X <br /> 3. Has Burnett County used$1 of each$5 fee collected under s.59.72(5),Wis.Stats.,to develop and <br /> maintain a computerized indexing of the county's land information records relating to housing,including <br /> the housing element of the county's land use plan under s.66.1001(2)(b),Stats.,in a manner that <br /> would allow for greater public access via the Internet? X <br /> Certification <br /> I,the designee or contact person for the Burnett County Land Information Office,certify under the penalty of perjury that the information <br /> provided in questions 1-3 is true and correct to the best of my knowledge. <br /> C--" ,-?,,Al.-1.--..7 <br /> .4, ems) O ,/o¢ 715-349-2539 <br /> LIO Si na ure(IC` y Swingle) Dat (m,rrldd/ccyy) Phone Number <br /> 4. Number of documents recorded and filed in the Burnett County Office of Register of Deeds under ss. 812 <br /> 59.43(2)(ag)1.&(e),Wis.Stats. <br /> 5. If auestions 1-3 are all answered yes.multiply the amount on Line 4 by$2 and enter the total here... $ 1,624.00 <br /> 6. If questions 1, 2 or 3 are answered no,multiply the amount on Line 4 by$7 and enter the total here $ <br /> 7. County Check Number: In the amount of: $ 1,624.00 <br /> Certification <br /> I,the Burnett County Register of Deeds,certify under the penalty of perjury that the information provided in questions 4-7 is true and <br /> correct to the best of my knowledge. <br /> _ /- U y 715-349-2183 <br /> ROD-Signature(Jeanine Chell) Date(mm/dd/ccyy) Phone Number <br />