Professional Services Reimbursement Notice FILL

Town of Mukwonago W320 S8315 Beulah Road Mukwonago, WI 53149 www.TownOfMukwonago.us Phone (262)363-4555 Fax (262)363-8377 TOWN OF MUKWONAGO PROFESSIONAL SERVICES REIMBURSEMENT NOTICE Pursuant to the Municipal Code of the Town of Mukwonago, Wisconsin, Section 2-2 and 2-3, the Town of Mukwonago Town Board has determined that whenever the services of the Town Attorney, Town Engineer, Town Planner, or any other of the Town’s professional staff results in a charge to the Town for that professional’s time and services and such service is not a service supplied to the Town as a whole, the Town Clerk shall charge that service for the fees incurred by the Town to the property owner incurring those fees, even if the request is not approved. Also, be advised that pursuant to the Municipal Code of the Town of Mukwonago, Wisconsin, certain other fees, costs, and charges are the responsibility of the property owner even if the request is not approved. Imposition of any fees, costs, or charges; however, is subject to the property owner’s appeal rights as described in said Municipal Code of the Town of Mukwonago, Wisconsin, I, t he undersigned, have been advised that pursuant to said Municipal Code of the Town of Mukwonago, Wisconsin, if the Town Attorney, Town Engineer, Town Planner, or any other Town professional provides services to the Town because of my activities, whether at my request or at the request of the Town, I shall be responsible for the fees incurred by the Town, even if the request is not approved. In addition, I have been advised that pursuant to said Municipal Code of the Town of Mukwonago, Wisconsin, certain other fees, costs, and charges are my responsibility even if the request is not approved. By signing this document; however, I am not waiving my appeal rights that are described in said Municipal Code of the Town of Mukwonago, Wisconsin. PLEASE PRINT LEGIBLY Name and Billing Address of Property Owner responsible for any outstanding Invoicing Phone # Cell # E-mail Address of property if different than above Tax Key Number of the Property involved in the Request: MUKT Description of project: _________________ __________ Date _____________________ ______ Da te _______________________________________________ Signature of Property Owner _______________________________________________ Signature of Authorized Agent _________________________________________________________ Signature of Town Official Planner $150/hr Attorney $216/hr Engineer up to $150/hr A copy of this completed form shall be provided to the Town Clerk for billing purposes. updated 4/7/25