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• WISCONSIN LAND INFORMATION PROGRAM / 6 +E•, <br /> RECORDING FEE SUBMISSION '. 1. f <br /> I .l Via:' ,ej <br /> .INSTRUCTIONS: 1. Send all fees by the 16th of each month. - ::Y= '' . <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 /> P <br /> WI Land Information Program <br /> P.O. Box 7869 <br /> Madison, WI 53707-7869 <br /> J <br /> SECTION A <br /> County Name Reporting Period <br /> RurnP -f- County DECEMBER 1996 <br /> Mailing Address <br /> 741 n County 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)7 <br /> If so,date established? <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 or contact person for the Land Information Office,certify under the penalty of perjury that the <br /> information provided in Section B is tnie and correct to the best of my knowledge. <br /> �97 715-349-2599 <br /> ignature bate 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)? 414 <br /> 4. If you have answered yes to both questions in Section B,multiply the amount on Line 3 by$2.00 and enter the total here: $ R2R-nn <br /> 5. If you have answered no to either questions in Section B,multiply the amount on Line 3 by$4.00 and enter the total here: $ _ <br /> 6. Amount submitted: $ R2R nn <br /> CERTIFICATION <br /> I,the Register of Deeds,certify under the penalty of perjury that the information provided in Section C is true and correct to the best of my knowledge. <br /> \odes„,71_, 2-/6 /�7 715=34 —21 R 1 <br /> Signature Date <br /> Phone No. <br />