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Request for Sharing of Non-Manufacturing Omitted Property Taxes
Wisconsin Department of RevenuePC-205 (N. 10-10) R614
See reverse side of form for DOR determination and explanation.
1
2
3
4
5
6
8
(Section 74.315, Wis. Stats.) DOR USE ONLY
Real Estate Parcel No.
Name of Property Owner
Real Estate
Year Tax Omitted
CASE NO.Town County Co Mun Code
TID # (if applicable):
Village City of
Omitted Assessed Value
Class(a)
Land(b)
Improvement(c)
Total (a + b)
Totals
Omitted Value
Net Omitted Taxes to be Shared With Taxing Jurisdictions - EXCLUDING INTEREST
a.
b.
c.1
c.2
d.
e.
f.
g.
h.
Code Name of Taxing Jurisdictions Net Tax
State of Wisconsin
County
Captured explanation.
Municipality (Local)
Total Net Tax Rescinded or Refunded - EXCLUDING INTEREST
Personal Property Account No.
Year added to Tax Roll
Personal Property
7 Was the omitted tax offset by a related corresponding adjustment?a.If Yes,provide:
Was a chargeback form (PC-201) filed for this related parcel/account number?b.
Parcel/Account No. Tax Amount
Yes No
Yes No
19 0115
2017 2018XLINCOLN ADAMS 01 016
X016-09030-0000
LIQUID POWER SPECIALTY PRODUCTS
.00 .00 .00
284,000.00
.00 2,000.02
.00
.00 491.29
01 0014 SCH D OF ADAMS FRIENDSHIP AREA 2,454.88 .00
00 1400 MID-STATE TECHNICAL COLLEGE WRAP 235.85 5,182.04
X
X
When the assessor added 2016 and 2017 omitted taxes to the 2018 tax roll with an assessment roll change, it was missed by everyone. First the Adams County Treasurer told Lincoln to send an individual bill (prepared by the County Treasurer) to the company to try and get the money back. There was no response. Discussion with Lynn Oldenburg, Local Government Services, suggested it be added to the SOA and SOT which it
Wisconsin Department of RevenuePC-205 (N. 10-10) R614B
9
10
11
12
NO
- 2 -
Qualify for equalization test?
DEPARTMENT OF REVENUE DETERMINATION
If "NO", notify tax district clerk that no action will be taken.
YES If "YES", continue.
NOWould the If "NO", notify tax district clerk that no action will be taken.
YES If "YES", we will:
equalizedvalue have been different?
EITHER
OR
Adjust the equalized value by $
and the equalized value by $
Allow the sharing of the omitted taxes to the taxing jurisdictions.
Explanation of Determination:
Certify results and issue instructions to the clerks of the tax district.
2017
X
X
X
X
Personal property was omitted from the assessment roll and
not included on the Municipal Assessment Report.
The Equalized Value is impacted. TJP
Request for Sharing of Non-Manufacturing Omitted Property Taxes
Wisconsin Department of RevenuePC-205 (N. 10-10) R614
See reverse side of form for DOR determination and explanation.
1
2
3
4
5
6
8
(Section 74.315, Wis. Stats.) DOR USE ONLY
Real Estate Parcel No.
Name of Property Owner
Real Estate
Year Tax Omitted
CASE NO.Town County Co Mun Code
TID # (if applicable):
Village City of
Omitted Assessed Value
Class(a)
Land(b)
Improvement(c)
Total (a + b)
Totals
Omitted Value
Net Omitted Taxes to be Shared With Taxing Jurisdictions - EXCLUDING INTEREST
a.
b.
c.1
c.2
d.
e.
f.
g.
h.
Code Name of Taxing Jurisdictions Net Tax
State of Wisconsin
County
Captured explanation.
Municipality (Local)
Total Net Tax Rescinded or Refunded - EXCLUDING INTEREST
Personal Property Account No.
Year added to Tax Roll
Personal Property
7 Was the omitted tax offset by a related corresponding adjustment?a.If Yes,provide:
Was a chargeback form (PC-201) filed for this related parcel/account number?b.
Parcel/Account No. Tax Amount
Yes No
Yes No
19 0036
2017 2018X LA POINTE ASHLAND 02 014
X 014-00099-0150
DAVID KITTLESON TRUST
1 .00 295,900.00 295,900.00
.00 295,900.00 295,900.00
.00 1,519.21
02 7030 MADELINE SANITARY DISTRICT 23.46 .00
1,607.82 04 0315 SCH D OF BAYFIELD 2,691.17 .00 00 1700 WISCONSIN INDIANHEAD TECH COLLEGE SHEL 97.44
5,939.10
X
X
Assessor stated the house was never assessed.
Wisconsin Department of RevenuePC-205 (N. 10-10) R614B
9
10
11
12
NO
- 2 -
Qualify for equalization test?
DEPARTMENT OF REVENUE DETERMINATION
If "NO", notify tax district clerk that no action will be taken.
YES If "YES", continue.
NOWould the If "NO", notify tax district clerk that no action will be taken.
YES If "YES", we will:
equalizedvalue have been different?
EITHER
OR
Adjust the equalized value by $
and the equalized value by $
Allow the sharing of the omitted taxes to the taxing jurisdictions.
Explanation of Determination:
Certify results and issue instructions to the clerks of the tax district.
2017
X
X
X
X
New construction was omitted from the assessment roll and
not included on the Municipal Assessment Report.
Therefore the Equalized Value was impacted.
Request for Sharing of Non-Manufacturing Omitted Property Taxes
Wisconsin Department of RevenuePC-205 (N. 10-10) R614
See reverse side of form for DOR determination and explanation.
1
2
3
4
5
6
8
(Section 74.315, Wis. Stats.) DOR USE ONLY
Real Estate Parcel No.
Name of Property Owner
Real Estate
Year Tax Omitted
CASE NO.Town County Co Mun Code
TID # (if applicable):
Village City of
Omitted Assessed Value
Class(a)
Land(b)
Improvement(c)
Total (a + b)
Totals
Omitted Value
Net Omitted Taxes to be Shared With Taxing Jurisdictions - EXCLUDING INTEREST
a.
b.
c.1
c.2
d.
e.
f.
g.
h.
Code Name of Taxing Jurisdictions Net Tax
State of Wisconsin
County
Captured explanation.
Municipality (Local)
Total Net Tax Rescinded or Refunded - EXCLUDING INTEREST
Personal Property Account No.
Year added to Tax Roll
Personal Property
7 Was the omitted tax offset by a related corresponding adjustment?a.If Yes,provide:
Was a chargeback form (PC-201) filed for this related parcel/account number?b.
Parcel/Account No. Tax Amount
Yes No
Yes No
19 0037
2016 2018X LA POINTE ASHLAND 02 014
X 014-00099-0150
DAVID KITTLESON TRUST
1 .00 295,900.00 295,900.00
.00 295,900.00 295,900.00
43.91 1,418.59
02 7030 MADELINE SANITARY DISTRICT 23.53 .00
1,646.69 04 0315 SCH D OF BAYFIELD 2,718.84 .00 00 1700 WISCONSIN INDIANHEAD TECH COLLEGE SHEL 97.70
5,949.26
X
X
Assessor stated the house was never assessed.
Wisconsin Department of RevenuePC-205 (N. 10-10) R614B
9
10
11
12
NO
- 2 -
Qualify for equalization test?
DEPARTMENT OF REVENUE DETERMINATION
If "NO", notify tax district clerk that no action will be taken.
YES If "YES", continue.
NOWould the If "NO", notify tax district clerk that no action will be taken.
YES If "YES", we will:
equalizedvalue have been different?
EITHER
OR
Adjust the equalized value by $
and the equalized value by $
Allow the sharing of the omitted taxes to the taxing jurisdictions.
Explanation of Determination:
Certify results and issue instructions to the clerks of the tax district.
2016
X
X
X
X
New construction was omitted from the assessment roll and
not included on the Municipal Assessment Report.
Therefore the Equalized Value was impacted.
Request for Sharing of Non-Manufacturing Omitted Property Taxes
Wisconsin Department of RevenuePC-205 (N. 10-10) R614
See reverse side of form for DOR determination and explanation.
1
2
3
4
5
6
8
(Section 74.315, Wis. Stats.) DOR USE ONLY
Real Estate Parcel No.
Name of Property Owner
Real Estate
Year Tax Omitted
CASE NO.Town County Co Mun Code
TID # (if applicable):
Village City of
Omitted Assessed Value
Class(a)
Land(b)
Improvement(c)
Total (a + b)
Totals
Omitted Value
Net Omitted Taxes to be Shared With Taxing Jurisdictions - EXCLUDING INTEREST
a.
b.
c.1
c.2
d.
e.
f.
g.
h.
Code Name of Taxing Jurisdictions Net Tax
State of Wisconsin
County
Captured explanation.
Municipality (Local)
Total Net Tax Rescinded or Refunded - EXCLUDING INTEREST
Personal Property Account No.
Year added to Tax Roll
Personal Property
7 Was the omitted tax offset by a related corresponding adjustment?a.If Yes,provide:
Was a chargeback form (PC-201) filed for this related parcel/account number?b.
Parcel/Account No. Tax Amount
Yes No
Yes No
19 0059
2018 2019 XGREEN BAY BROWN 05 231
X27568 014
HILLSTROM COMMUNICATIONS INC
.00 .00 .00
17,900.00
.00 71.95
05 5040 GREEN BAY METRO SEWER DISTRICT .00 .00
166.23 05 2289 SCH D OF GREEN BAY AREA 166.68 .00 00 1300 NORTHEAST WISCONSIN TECH COLLEGE GNBY 13.72
418.58
X
X
Personal property was reported by owner after the Board of Review closed on May 9, 2018.
Wisconsin Department of RevenuePC-205 (N. 10-10) R614B
9
10
11
12
NO
- 2 -
Qualify for equalization test?
DEPARTMENT OF REVENUE DETERMINATION
If "NO", notify tax district clerk that no action will be taken.
YES If "YES", continue.
NOWould the If "NO", notify tax district clerk that no action will be taken.
YES If "YES", we will:
equalizedvalue have been different?
EITHER
OR
Adjust the equalized value by $
and the equalized value by $
Allow the sharing of the omitted taxes to the taxing jurisdictions.
Explanation of Determination:
Certify results and issue instructions to the clerks of the tax district.
2018
X
X
X
Request for Sharing of Non-Manufacturing Omitted Property Taxes
Wisconsin Department of RevenuePC-205 (N. 10-10) R614
See reverse side of form for DOR determination and explanation.
1
2
3
4
5
6
8
(Section 74.315, Wis. Stats.) DOR USE ONLY
Real Estate Parcel No.
Name of Property Owner
Real Estate
Year Tax Omitted
CASE NO.Town County Co Mun Code
TID # (if applicable):
Village City of
Omitted Assessed Value
Class(a)
Land(b)
Improvement(c)
Total (a + b)
Totals
Omitted Value
Net Omitted Taxes to be Shared With Taxing Jurisdictions - EXCLUDING INTEREST
a.
b.
c.1
c.2
d.
e.
f.
g.
h.
Code Name of Taxing Jurisdictions Net Tax
State of Wisconsin
County
Captured explanation.
Municipality (Local)
Total Net Tax Rescinded or Refunded - EXCLUDING INTEREST
Personal Property Account No.
Year added to Tax Roll
Personal Property
7 Was the omitted tax offset by a related corresponding adjustment?a.If Yes,provide:
Was a chargeback form (PC-201) filed for this related parcel/account number?b.
Parcel/Account No. Tax Amount
Yes No
Yes No
19 0061
2018 2019 XGREEN BAY BROWN 05 231
X27563 012
LORIS GIFTS LLC
.00 .00 .00
9,500.00
.00 38.19
05 5040 GREEN BAY METRO SEWER DISTRICT .00 .00
88.22 05 2289 SCH D OF GREEN BAY AREA 88.46 .00 00 1300 NORTHEAST WISCONSIN TECH COLLEGE GNBY 7.28
222.15
X
X
Personal property was reported by the owner after the Board of Review closed on May 9, 2018.
Wisconsin Department of RevenuePC-205 (N. 10-10) R614B
9
10
11
12
NO
- 2 -
Qualify for equalization test?
DEPARTMENT OF REVENUE DETERMINATION
If "NO", notify tax district clerk that no action will be taken.
YES If "YES", continue.
NOWould the If "NO", notify tax district clerk that no action will be taken.
YES If "YES", we will:
equalizedvalue have been different?
EITHER
OR
Adjust the equalized value by $
and the equalized value by $
Allow the sharing of the omitted taxes to the taxing jurisdictions.
Explanation of Determination:
Certify results and issue instructions to the clerks of the tax district.
2018
X
X
X
Request for Sharing of Non-Manufacturing Omitted Property Taxes
Wisconsin Department of RevenuePC-205 (N. 10-10) R614
See reverse side of form for DOR determination and explanation.
1
2
3
4
5
6
8
(Section 74.315, Wis. Stats.) DOR USE ONLY
Real Estate Parcel No.
Name of Property Owner
Real Estate
Year Tax Omitted
CASE NO.Town County Co Mun Code
TID # (if applicable):
Village City of
Omitted Assessed Value
Class(a)
Land(b)
Improvement(c)
Total (a + b)
Totals
Omitted Value
Net Omitted Taxes to be Shared With Taxing Jurisdictions - EXCLUDING INTEREST
a.
b.
c.1
c.2
d.
e.
f.
g.
h.
Code Name of Taxing Jurisdictions Net Tax
State of Wisconsin
County
Captured explanation.
Municipality (Local)
Total Net Tax Rescinded or Refunded - EXCLUDING INTEREST
Personal Property Account No.
Year added to Tax Roll
Personal Property
7 Was the omitted tax offset by a related corresponding adjustment?a.If Yes,provide:
Was a chargeback form (PC-201) filed for this related parcel/account number?b.
Parcel/Account No. Tax Amount
Yes No
Yes No
19 0055
2017 2018X HOWARD CHIPPEWA 09 032
X 032-007087 032-007088
ROBERT SCHINDLER JEFF SIKORA
1 .00 543,400.00 543,400.00
.00 543,400.00 543,400.00
.00 1,857.24
.00 .00
1,396.53 17 1176 SCH D OF COLFAX 4,137.64 .00 00 0100 CHIPPEWA VALLEY TECHNICAL COLLEGE EAUC 424.58
7,815.99
X
X
Assessor failed to assess residence on parcel that was manufacturing assessed by state.
Wisconsin Department of RevenuePC-205 (N. 10-10) R614B
9
10
11
12
NO
- 2 -
Qualify for equalization test?
DEPARTMENT OF REVENUE DETERMINATION
If "NO", notify tax district clerk that no action will be taken.
YES If "YES", continue.
NOWould the If "NO", notify tax district clerk that no action will be taken.
YES If "YES", we will:
equalizedvalue have been different?
EITHER
OR
Adjust the equalized value by $
and the equalized value by $
Allow the sharing of the omitted taxes to the taxing jurisdictions.
Explanation of Determination:
Certify results and issue instructions to the clerks of the tax district.
2017
X
X
X
X
Personal property was omitted from the assessment roll and
not included on the Municipal Assessment Report.
The Equalized Value is impacted.
Request for Sharing of Non-Manufacturing Omitted Property Taxes
Wisconsin Department of RevenuePC-205 (N. 10-10) R614
See reverse side of form for DOR determination and explanation.
1
2
3
4
5
6
8
(Section 74.315, Wis. Stats.) DOR USE ONLY
Real Estate Parcel No.
Name of Property Owner
Real Estate
Year Tax Omitted
CASE NO.Town County Co Mun Code
TID # (if applicable):
Village City of
Omitted Assessed Value
Class(a)
Land(b)
Improvement(c)
Total (a + b)
Totals
Omitted Value
Net Omitted Taxes to be Shared With Taxing Jurisdictions - EXCLUDING INTEREST
a.
b.
c.1
c.2
d.
e.
f.
g.
h.
Code Name of Taxing Jurisdictions Net Tax
State of Wisconsin
County
Captured explanation.
Municipality (Local)
Total Net Tax Rescinded or Refunded - EXCLUDING INTEREST
Personal Property Account No.
Year added to Tax Roll
Personal Property
7 Was the omitted tax offset by a related corresponding adjustment?a.If Yes,provide:
Was a chargeback form (PC-201) filed for this related parcel/account number?b.
Parcel/Account No. Tax Amount
Yes No
Yes No
19 0208
2016 2018X HOWARD CHIPPEWA 09 032
X 032-007087 032-007088
ROBERT SCHINDLER JEFF SIKORA
1 .00 543,400.00 543,400.00
.00 543,400.00 543,400.00
83.85 1,865.18
.00 .00
1,411.82 17 1176 SCH D OF COLFAX 4,371.84 .00 00 0100 CHIPPEWA VALLEY TECHNICAL COLLEGE EAUC 433.71
8,166.40
X
X
Assessor failed to assess residence on parcel that was manufacturing assessed by state.
Wisconsin Department of RevenuePC-205 (N. 10-10) R614B
9
10
11
12
NO
- 2 -
Qualify for equalization test?
DEPARTMENT OF REVENUE DETERMINATION
If "NO", notify tax district clerk that no action will be taken.
YES If "YES", continue.
NOWould the If "NO", notify tax district clerk that no action will be taken.
YES If "YES", we will:
equalizedvalue have been different?
EITHER
OR
Adjust the equalized value by $
and the equalized value by $
Allow the sharing of the omitted taxes to the taxing jurisdictions.
Explanation of Determination:
Certify results and issue instructions to the clerks of the tax district.
2016
X
X
X
X
Personal property was omitted from the assessment roll and
not included on the Municipal Assessment Report.
The Equalized Value is impacted.
Request for Sharing of Non-Manufacturing Omitted Property Taxes
Wisconsin Department of RevenuePC-205 (N. 10-10) R614
See reverse side of form for DOR determination and explanation.
1
2
3
4
5
6
8
(Section 74.315, Wis. Stats.) DOR USE ONLY
Real Estate Parcel No.
Name of Property Owner
Real Estate
Year Tax Omitted
CASE NO.Town County Co Mun Code
TID # (if applicable):
Village City of
Omitted Assessed Value
Class(a)
Land(b)
Improvement(c)
Total (a + b)
Totals
Omitted Value
Net Omitted Taxes to be Shared With Taxing Jurisdictions - EXCLUDING INTEREST
a.
b.
c.1
c.2
d.
e.
f.
g.
h.
Code Name of Taxing Jurisdictions Net Tax
State of Wisconsin
County
Captured explanation.
Municipality (Local)
Total Net Tax Rescinded or Refunded - EXCLUDING INTEREST
Personal Property Account No.
Year added to Tax Roll
Personal Property
7 Was the omitted tax offset by a related corresponding adjustment?a.If Yes,provide:
Was a chargeback form (PC-201) filed for this related parcel/account number?b.
Parcel/Account No. Tax Amount
Yes No
Yes No
19 0072
2018 2019X FOUNTAIN PRAIRIE COLUMBIA 11 014
X 11014 0395.01
LANDMARK SERVICES COOPERATIVE
2 .00 636,500.00 636,500.00
.00 636,500.00 636,500.00
.00 2,881.07
.00 .00
2,601.67 11 1736 SCH D OF FALL RIVER 4,892.27 .00 00 0400 MADISON AREA TECHNICAL COLLEGE MADN 517.33
10,892.34
X
X
A building permit was taken out for a structure on this parcel, but no building was completed the first year. The second year, the structure was completed, but the assessor did not realize that it had been completed in the second year.
Wisconsin Department of RevenuePC-205 (N. 10-10) R614B
9
10
11
12
NO
- 2 -
Qualify for equalization test?
DEPARTMENT OF REVENUE DETERMINATION
If "NO", notify tax district clerk that no action will be taken.
YES If "YES", continue.
NOWould the If "NO", notify tax district clerk that no action will be taken.
YES If "YES", we will:
equalizedvalue have been different?
EITHER
OR
Adjust the equalized value by $
and the equalized value by $
Allow the sharing of the omitted taxes to the taxing jurisdictions.
Explanation of Determination:
Certify results and issue instructions to the clerks of the tax district.
2018
X
X
X
X
NEW CONSTRUCTION WAS OMITTED FROM THE ASSESSMENT ROLL AND
NOT INCLUDED ON THE MUNICIPAL ASSESSMENT REPORT. THEREFORE
THE EQUALIZED VALUE WAS IMPACTED.
Request for Sharing of Non-Manufacturing Omitted Property Taxes
Wisconsin Department of RevenuePC-205 (N. 10-10) R614
See reverse side of form for DOR determination and explanation.
1
2
3
4
5
6
8
(Section 74.315, Wis. Stats.) DOR USE ONLY
Real Estate Parcel No.
Name of Property Owner
Real Estate
Year Tax Omitted
CASE NO.Town County Co Mun Code
TID # (if applicable):
Village City of
Omitted Assessed Value
Class(a)
Land(b)
Improvement(c)
Total (a + b)
Totals
Omitted Value
Net Omitted Taxes to be Shared With Taxing Jurisdictions - EXCLUDING INTEREST
a.
b.
c.1
c.2
d.
e.
f.
g.
h.
Code Name of Taxing Jurisdictions Net Tax
State of Wisconsin
County
Captured explanation.
Municipality (Local)
Total Net Tax Rescinded or Refunded - EXCLUDING INTEREST
Personal Property Account No.
Year added to Tax Roll
Personal Property
7 Was the omitted tax offset by a related corresponding adjustment?a.If Yes,provide:
Was a chargeback form (PC-201) filed for this related parcel/account number?b.
Parcel/Account No. Tax Amount
Yes No
Yes No
19 0095
2018 2019 XPORTAGE COLUMBIA 11 271
X 3147.115
WILLIAM AND SAMANTHA LAUGHLIN
1 .00 275,100.00 275,100.00
.00 275,100.00 275,100.00
.00 1,200.88
.00 .00
2,349.28 11 4501 SCH D OF PORTAGE COMMUNITY 2,299.71 .00 00 0400 MADISON AREA TECHNICAL COLLEGE MADN 225.14
6,075.01
X
X
The new home should have been placed on the assessment roll for 2018 but was missed by the Assessor.
Wisconsin Department of RevenuePC-205 (N. 10-10) R614B
9
10
11
12
NO
- 2 -
Qualify for equalization test?
DEPARTMENT OF REVENUE DETERMINATION
If "NO", notify tax district clerk that no action will be taken.
YES If "YES", continue.
NOWould the If "NO", notify tax district clerk that no action will be taken.
YES If "YES", we will:
equalizedvalue have been different?
EITHER
OR
Adjust the equalized value by $
and the equalized value by $
Allow the sharing of the omitted taxes to the taxing jurisdictions.
Explanation of Determination:
Certify results and issue instructions to the clerks of the tax district.
2018
X
X
X
X
NEW CONSTRUCTION WAS OMITTED FROM THE ASSESSMENT ROLL AND
NOT INCLUDED ON THE MUNICIPAL ASSESSMENT REPORT. THEREFORE
THE EQUALIZED VALUE WAS IMPACTED.
Request for Sharing of Non-Manufacturing Omitted Property Taxes
Wisconsin Department of RevenuePC-205 (N. 10-10) R614
See reverse side of form for DOR determination and explanation.
1
2
3
4
5
6
8
(Section 74.315, Wis. Stats.) DOR USE ONLY
Real Estate Parcel No.
Name of Property Owner
Real Estate
Year Tax Omitted
CASE NO.Town County Co Mun Code
TID # (if applicable):
Village City of
Omitted Assessed Value
Class(a)
Land(b)
Improvement(c)
Total (a + b)
Totals
Omitted Value
Net Omitted Taxes to be Shared With Taxing Jurisdictions - EXCLUDING INTEREST
a.
b.
c.1
c.2
d.
e.
f.
g.
h.
Code Name of Taxing Jurisdictions Net Tax
State of Wisconsin
County
Captured explanation.
Municipality (Local)
Total Net Tax Rescinded or Refunded - EXCLUDING INTEREST
Personal Property Account No.
Year added to Tax Roll
Personal Property
7 Was the omitted tax offset by a related corresponding adjustment?a.If Yes,provide:
Was a chargeback form (PC-201) filed for this related parcel/account number?b.
Parcel/Account No. Tax Amount
Yes No
Yes No
19 0193
2017 2019X PERRY DANE 13 044
X 050601180820
ANDREW JUDD
1 .00 242,600.00 242,600.00
.00 242,600.00 242,600.00
.00 779.52
.00 .00
848.99 13 3794 SCH D OF MOUNT HOREB AREA 2,274.03 .00 00 0400 MADISON AREA TECHNICAL COLLEGE MADN 204.57
4,107.11
X
X
Assessor error
Wisconsin Department of RevenuePC-205 (N. 10-10) R614B
9
10
11
12
NO
- 2 -
Qualify for equalization test?
DEPARTMENT OF REVENUE DETERMINATION
If "NO", notify tax district clerk that no action will be taken.
YES If "YES", continue.
NOWould the If "NO", notify tax district clerk that no action will be taken.
YES If "YES", we will:
equalizedvalue have been different?
EITHER
OR
Adjust the equalized value by $
and the equalized value by $
Allow the sharing of the omitted taxes to the taxing jurisdictions.
Explanation of Determination:
Certify results and issue instructions to the clerks of the tax district.
2017
X
X
X
X
NEW CONSTRUCTION WAS OMITTED FROM THE ASSESSMENT ROLL AND
NOT INCLUDED ON THE MUNICIPAL ASSESSMENT REPORT. THEREFORE
THE EQUALIZED VALUE WAS IMPACTED.
Request for Sharing of Non-Manufacturing Omitted Property Taxes
Wisconsin Department of RevenuePC-205 (N. 10-10) R614
See reverse side of form for DOR determination and explanation.
1
2
3
4
5
6
8
(Section 74.315, Wis. Stats.) DOR USE ONLY
Real Estate Parcel No.
Name of Property Owner
Real Estate
Year Tax Omitted
CASE NO.Town County Co Mun Code
TID # (if applicable):
Village City of
Omitted Assessed Value
Class(a)
Land(b)
Improvement(c)
Total (a + b)
Totals
Omitted Value
Net Omitted Taxes to be Shared With Taxing Jurisdictions - EXCLUDING INTEREST
a.
b.
c.1
c.2
d.
e.
f.
g.
h.
Code Name of Taxing Jurisdictions Net Tax
State of Wisconsin
County
Captured explanation.
Municipality (Local)
Total Net Tax Rescinded or Refunded - EXCLUDING INTEREST
Personal Property Account No.
Year added to Tax Roll
Personal Property
7 Was the omitted tax offset by a related corresponding adjustment?a.If Yes,provide:
Was a chargeback form (PC-201) filed for this related parcel/account number?b.
Parcel/Account No. Tax Amount
Yes No
Yes No
19 0197
2018 2019X PERRY DANE 13 044
X 050601180820
ANDREW JUDD
1 .00 242,600.00 242,600.00
.00 242,600.00 242,600.00
.00 744.97
.00 .00
927.89 13 3794 SCH D OF MOUNT HOREB AREA 2,079.11 .00 00 0400 MADISON AREA TECHNICAL COLLEGE MADN 200.14
3,952.11
X
X
Assessor error
Wisconsin Department of RevenuePC-205 (N. 10-10) R614B
9
10
11
12
NO
- 2 -
Qualify for equalization test?
DEPARTMENT OF REVENUE DETERMINATION
If "NO", notify tax district clerk that no action will be taken.
YES If "YES", continue.
NOWould the If "NO", notify tax district clerk that no action will be taken.
YES If "YES", we will:
equalizedvalue have been different?
EITHER
OR
Adjust the equalized value by $
and the equalized value by $
Allow the sharing of the omitted taxes to the taxing jurisdictions.
Explanation of Determination:
Certify results and issue instructions to the clerks of the tax district.
2018
X
X
X
X
NEW CONSTRUCTION WAS OMITTED FROM THE ASSESSMENT ROLL AND
NOT INCLUDED ON THE MUNICIPAL ASSESSMENT REPORT. THEREFORE
THE EQUALIZED VALUE WAS IMPACTED.
Request for Sharing of Non-Manufacturing Omitted Property Taxes
Wisconsin Department of RevenuePC-205 (N. 10-10) R614
See reverse side of form for DOR determination and explanation.
1
2
3
4
5
6
8
(Section 74.315, Wis. Stats.) DOR USE ONLY
Real Estate Parcel No.
Name of Property Owner
Real Estate
Year Tax Omitted
CASE NO.Town County Co Mun Code
TID # (if applicable):
Village City of
Omitted Assessed Value
Class(a)
Land(b)
Improvement(c)
Total (a + b)
Totals
Omitted Value
Net Omitted Taxes to be Shared With Taxing Jurisdictions - EXCLUDING INTEREST
a.
b.
c.1
c.2
d.
e.
f.
g.
h.
Code Name of Taxing Jurisdictions Net Tax
State of Wisconsin
County
Captured explanation.
Municipality (Local)
Total Net Tax Rescinded or Refunded - EXCLUDING INTEREST
Personal Property Account No.
Year added to Tax Roll
Personal Property
7 Was the omitted tax offset by a related corresponding adjustment?a.If Yes,provide:
Was a chargeback form (PC-201) filed for this related parcel/account number?b.
Parcel/Account No. Tax Amount
Yes No
Yes No
19 0129
2017 2018 XMADISON DANE 13 251
X 0709-231-1616-9
MADISON DEVELOPMENT CORPORATION
2 291,000.00 679,000.00 970,000.00
291,000.00 679,000.00 970,000.00
.00 2,623.86
.00 .00
9,038.12 13 3269 SCH D OF MADISON METROPOLITAN 10,141.45 .00 00 0400 MADISON AREA TECHNICAL COLLEGE MADN 826.07
22,629.50
X
X
Property taxes for 2017 were omitted due to incorrect reporting on the 2017 Certificate of Occupancy report filed by owner of low-income housing facility. All units at this address are assessable instead of exempt per revised report received in December 2017. Taxes to be added to the 2018 tax roll.
Wisconsin Department of RevenuePC-205 (N. 10-10) R614B
9
10
11
12
NO
- 2 -
Qualify for equalization test?
DEPARTMENT OF REVENUE DETERMINATION
If "NO", notify tax district clerk that no action will be taken.
YES If "YES", continue.
NOWould the If "NO", notify tax district clerk that no action will be taken.
YES If "YES", we will:
equalizedvalue have been different?
EITHER
OR
Adjust the equalized value by $
and the equalized value by $
Allow the sharing of the omitted taxes to the taxing jurisdictions.
Explanation of Determination:
Certify results and issue instructions to the clerks of the tax district.
2017
X
X
X
X
PREVIOUSLY ASSESSED REAL PROPERTY WAS ERRONEOUSLY DETERMINED
TO BE EXEMPT. THE PROPERTY WAS REPORTED ON THE mUNICIPAL
ASSESSMENT REPORT AS "FORMERLY TAXABLE, NOW EXEMPT" WHICH
IMPACTED THE EQUALIZED VALUE.
Request for Sharing of Non-Manufacturing Omitted Property Taxes
Wisconsin Department of RevenuePC-205 (N. 10-10) R614
See reverse side of form for DOR determination and explanation.
1
2
3
4
5
6
8
(Section 74.315, Wis. Stats.) DOR USE ONLY
Real Estate Parcel No.
Name of Property Owner
Real Estate
Year Tax Omitted
CASE NO.Town County Co Mun Code
TID # (if applicable):
Village City of
Omitted Assessed Value
Class(a)
Land(b)
Improvement(c)
Total (a + b)
Totals
Omitted Value
Net Omitted Taxes to be Shared With Taxing Jurisdictions - EXCLUDING INTEREST
a.
b.
c.1
c.2
d.
e.
f.
g.
h.
Code Name of Taxing Jurisdictions Net Tax
State of Wisconsin
County
Captured explanation.
Municipality (Local)
Total Net Tax Rescinded or Refunded - EXCLUDING INTEREST
Personal Property Account No.
Year added to Tax Roll
Personal Property
7 Was the omitted tax offset by a related corresponding adjustment?a.If Yes,provide:
Was a chargeback form (PC-201) filed for this related parcel/account number?b.
Parcel/Account No. Tax Amount
Yes No
Yes No
19 0024
2018 2019 XMIDDLETON DANE 13 255
X50-53800
KWIK TRIP INC
.00 .00 .00
9,250.00
.00 21.86
.00 .00
66.32 13 3549 SCH D OF MIDDLETON-CROSS PLAINS 70.61 .00 00 0400 MADISON AREA TECHNICAL COLLEGE MADN 6.70
165.49
X
X
Assessor missed entering the pc-201 form
Wisconsin Department of RevenuePC-205 (N. 10-10) R614B
9
10
11
12
NO
- 2 -
Qualify for equalization test?
DEPARTMENT OF REVENUE DETERMINATION
If "NO", notify tax district clerk that no action will be taken.
YES If "YES", continue.
NOWould the If "NO", notify tax district clerk that no action will be taken.
YES If "YES", we will:
equalizedvalue have been different?
EITHER
OR
Adjust the equalized value by $
and the equalized value by $
Allow the sharing of the omitted taxes to the taxing jurisdictions.
Explanation of Determination:
Certify results and issue instructions to the clerks of the tax district.
2018
X
X
X
X
PERSONAL PROPERTY WAS OMITTED FROM THE ASSESSMENT ROLL AND
NOT INCLUDED ON THE mUNICIPAL ASSESSMENT REPORT. THE
EQUALIZED VALUE IS IMPACTED.
Request for Sharing of Non-Manufacturing Omitted Property Taxes
Wisconsin Department of RevenuePC-205 (N. 10-10) R614
See reverse side of form for DOR determination and explanation.
1
2
3
4
5
6
8
(Section 74.315, Wis. Stats.) DOR USE ONLY
Real Estate Parcel No.
Name of Property Owner
Real Estate
Year Tax Omitted
CASE NO.Town County Co Mun Code
TID # (if applicable):
Village City of
Omitted Assessed Value
Class(a)
Land(b)
Improvement(c)
Total (a + b)
Totals
Omitted Value
Net Omitted Taxes to be Shared With Taxing Jurisdictions - EXCLUDING INTEREST
a.
b.
c.1
c.2
d.
e.
f.
g.
h.
Code Name of Taxing Jurisdictions Net Tax
State of Wisconsin
County
Captured explanation.
Municipality (Local)
Total Net Tax Rescinded or Refunded - EXCLUDING INTEREST
Personal Property Account No.
Year added to Tax Roll
Personal Property
7 Was the omitted tax offset by a related corresponding adjustment?a.If Yes,provide:
Was a chargeback form (PC-201) filed for this related parcel/account number?b.
Parcel/Account No. Tax Amount
Yes No
Yes No
19 0025
2018 2019 XMIDDLETON DANE 13 255
X50-53801
KWIK TRIP INC
.00 .00 .00
102,226.00
.00 241.55
.00 .00
732.94 13 3549 SCH D OF MIDDLETON-CROSS PLAINS 780.30 .00 00 0400 MADISON AREA TECHNICAL COLLEGE MADN 74.07
1,828.86
X
X
Assessor missed entering pc201
Wisconsin Department of RevenuePC-205 (N. 10-10) R614B
9
10
11
12
NO
- 2 -
Qualify for equalization test?
DEPARTMENT OF REVENUE DETERMINATION
If "NO", notify tax district clerk that no action will be taken.
YES If "YES", continue.
NOWould the If "NO", notify tax district clerk that no action will be taken.
YES If "YES", we will:
equalizedvalue have been different?
EITHER
OR
Adjust the equalized value by $
and the equalized value by $
Allow the sharing of the omitted taxes to the taxing jurisdictions.
Explanation of Determination:
Certify results and issue instructions to the clerks of the tax district.
2018
X
X
X
X
PERONAL PROPERTY WAS OMITTED FROM THE ASSESSMENT ROLL AND
NOT INCLUDED ON THE MUNICIPAL ASSESSMENT REPORT. THE
EQUALIZED VALUE IS IMPACTED.
Request for Sharing of Non-Manufacturing Omitted Property Taxes
Wisconsin Department of RevenuePC-205 (N. 10-10) R614
See reverse side of form for DOR determination and explanation.
1
2
3
4
5
6
8
(Section 74.315, Wis. Stats.) DOR USE ONLY
Real Estate Parcel No.
Name of Property Owner
Real Estate
Year Tax Omitted
CASE NO.Town County Co Mun Code
TID # (if applicable):
Village City of
Omitted Assessed Value
Class(a)
Land(b)
Improvement(c)
Total (a + b)
Totals
Omitted Value
Net Omitted Taxes to be Shared With Taxing Jurisdictions - EXCLUDING INTEREST
a.
b.
c.1
c.2
d.
e.
f.
g.
h.
Code Name of Taxing Jurisdictions Net Tax
State of Wisconsin
County
Captured explanation.
Municipality (Local)
Total Net Tax Rescinded or Refunded - EXCLUDING INTEREST
Personal Property Account No.
Year added to Tax Roll
Personal Property
7 Was the omitted tax offset by a related corresponding adjustment?a.If Yes,provide:
Was a chargeback form (PC-201) filed for this related parcel/account number?b.
Parcel/Account No. Tax Amount
Yes No
Yes No
19 0026
2018 2019 XMIDDLETON DANE 13 255
X50-53802
KWIK TRIP INC
.00 .00 .00
9,815.00
.00 23.19
.00 .00
70.37 13 3549 SCH D OF MIDDLETON-CROSS PLAINS 74.92 .00 00 0400 MADISON AREA TECHNICAL COLLEGE MADN 7.11
175.59
X
X
assessor missed adding to roll
Wisconsin Department of RevenuePC-205 (N. 10-10) R614B
9
10
11
12
NO
- 2 -
Qualify for equalization test?
DEPARTMENT OF REVENUE DETERMINATION
If "NO", notify tax district clerk that no action will be taken.
YES If "YES", continue.
NOWould the If "NO", notify tax district clerk that no action will be taken.
YES If "YES", we will:
equalizedvalue have been different?
EITHER
OR
Adjust the equalized value by $
and the equalized value by $
Allow the sharing of the omitted taxes to the taxing jurisdictions.
Explanation of Determination:
Certify results and issue instructions to the clerks of the tax district.
2018
X
X
X
X
PERSONAL PROPERTY WAS OMITTED FROM THE ASSESSMENT ROLL AND
NOT INCLUDED ON THE MUNICIPAL ASSESSMENT REPORT. THE
EQUALIZED VALUE IS IMPACTED.
Request for Sharing of Non-Manufacturing Omitted Property Taxes
Wisconsin Department of RevenuePC-205 (N. 10-10) R614
See reverse side of form for DOR determination and explanation.
1
2
3
4
5
6
8
(Section 74.315, Wis. Stats.) DOR USE ONLY
Real Estate Parcel No.
Name of Property Owner
Real Estate
Year Tax Omitted
CASE NO.Town County Co Mun Code
TID # (if applicable):
Village City of
Omitted Assessed Value
Class(a)
Land(b)
Improvement(c)
Total (a + b)
Totals
Omitted Value
Net Omitted Taxes to be Shared With Taxing Jurisdictions - EXCLUDING INTEREST
a.
b.
c.1
c.2
d.
e.
f.
g.
h.
Code Name of Taxing Jurisdictions Net Tax
State of Wisconsin
County
Captured explanation.
Municipality (Local)
Total Net Tax Rescinded or Refunded - EXCLUDING INTEREST
Personal Property Account No.
Year added to Tax Roll
Personal Property
7 Was the omitted tax offset by a related corresponding adjustment?a.If Yes,provide:
Was a chargeback form (PC-201) filed for this related parcel/account number?b.
Parcel/Account No. Tax Amount
Yes No
Yes No
19 0027
2018 2019 XMIDDLETON DANE 13 255
X 0809-314-0014-2
RYAN AND JESSICA GULDEN
1 .00 718,800.00 718,800.00
.00 718,800.00 718,800.00
.00 1,696.97
.00 .00
4,210.04 13 6181 SCH D OF WAUNAKEE COMMUNITY 6,295.89 .00 00 0400 MADISON AREA TECHNICAL COLLEGE MADN 520.35
12,723.25
X
X
assessor did not add improved value when home was completed
Wisconsin Department of RevenuePC-205 (N. 10-10) R614B
9
10
11
12
NO
- 2 -
Qualify for equalization test?
DEPARTMENT OF REVENUE DETERMINATION
If "NO", notify tax district clerk that no action will be taken.
YES If "YES", continue.
NOWould the If "NO", notify tax district clerk that no action will be taken.
YES If "YES", we will:
equalizedvalue have been different?
EITHER
OR
Adjust the equalized value by $
and the equalized value by $
Allow the sharing of the omitted taxes to the taxing jurisdictions.
Explanation of Determination:
Certify results and issue instructions to the clerks of the tax district.
2018
X
X
X
X
NEW CONSTRUCTION WAS OMITTED FROM THE ASSESSMENT ROLL AND
NOT INCLUDED ON THE MUNICIPAL ASSESSMENT REPORT. THEREFORE
THE EQUALIZED VALUE WAS IMPACTED.
Request for Sharing of Non-Manufacturing Omitted Property Taxes
Wisconsin Department of RevenuePC-205 (N. 10-10) R614
See reverse side of form for DOR determination and explanation.
1
2
3
4
5
6
8
(Section 74.315, Wis. Stats.) DOR USE ONLY
Real Estate Parcel No.
Name of Property Owner
Real Estate
Year Tax Omitted
CASE NO.Town County Co Mun Code
TID # (if applicable):
Village City of
Omitted Assessed Value
Class(a)
Land(b)
Improvement(c)
Total (a + b)
Totals
Omitted Value
Net Omitted Taxes to be Shared With Taxing Jurisdictions - EXCLUDING INTEREST
a.
b.
c.1
c.2
d.
e.
f.
g.
h.
Code Name of Taxing Jurisdictions Net Tax
State of Wisconsin
County
Captured explanation.
Municipality (Local)
Total Net Tax Rescinded or Refunded - EXCLUDING INTEREST
Personal Property Account No.
Year added to Tax Roll
Personal Property
7 Was the omitted tax offset by a related corresponding adjustment?a.If Yes,provide:
Was a chargeback form (PC-201) filed for this related parcel/account number?b.
Parcel/Account No. Tax Amount
Yes No
Yes No
19 0028
2017 2019 XMIDDLETON DANE 13 255
X 0809-314-0014-2
RYAN AND JESSICA GULDEN
1 .00 611,000.00 611,000.00
.00 611,000.00 611,000.00
.00 1,660.80
.00 .00
4,047.85 13 6181 SCH D OF WAUNAKEE COMMUNITY 7,039.12 .00 00 0400 MADISON AREA TECHNICAL COLLEGE MADN 497.51
13,245.28
X
X
assessor did not add improved value to assessment after home was finished
Wisconsin Department of RevenuePC-205 (N. 10-10) R614B
9
10
11
12
NO
- 2 -
Qualify for equalization test?
DEPARTMENT OF REVENUE DETERMINATION
If "NO", notify tax district clerk that no action will be taken.
YES If "YES", continue.
NOWould the If "NO", notify tax district clerk that no action will be taken.
YES If "YES", we will:
equalizedvalue have been different?
EITHER
OR
Adjust the equalized value by $
and the equalized value by $
Allow the sharing of the omitted taxes to the taxing jurisdictions.
Explanation of Determination:
Certify results and issue instructions to the clerks of the tax district.
2017
X
X
X
X
NEW CONSTRUCTION WAS OMITTED FROM THE ASSESSMENT ROLL AND
NOT INCLUDED ON THE MUNICIPAL ASSESSMENT REPORT. THEREFORE
THE EQUALIZED VALUE WAS IMPACTED.
Request for Sharing of Non-Manufacturing Omitted Property Taxes
Wisconsin Department of RevenuePC-205 (N. 10-10) R614
See reverse side of form for DOR determination and explanation.
1
2
3
4
5
6
8
(Section 74.315, Wis. Stats.) DOR USE ONLY
Real Estate Parcel No.
Name of Property Owner
Real Estate
Year Tax Omitted
CASE NO.Town County Co Mun Code
TID # (if applicable):
Village City of
Omitted Assessed Value
Class(a)
Land(b)
Improvement(c)
Total (a + b)
Totals
Omitted Value
Net Omitted Taxes to be Shared With Taxing Jurisdictions - EXCLUDING INTEREST
a.
b.
c.1
c.2
d.
e.
f.
g.
h.
Code Name of Taxing Jurisdictions Net Tax
State of Wisconsin
County
Captured explanation.
Municipality (Local)
Total Net Tax Rescinded or Refunded - EXCLUDING INTEREST
Personal Property Account No.
Year added to Tax Roll
Personal Property
7 Was the omitted tax offset by a related corresponding adjustment?a.If Yes,provide:
Was a chargeback form (PC-201) filed for this related parcel/account number?b.
Parcel/Account No. Tax Amount
Yes No
Yes No
19 0029
2018 2019 XEAU CLAIRE EAU CLAIRE 18 221
X 07-0140
EMPIRE PROPERTIES
1 .00 87,800.00 87,800.00
.00 87,800.00 87,800.00
.00 304.79
.00 .00
682.05 18 1554 SCH D OF EAU CLAIRE AREA 679.03 .00 00 0100 CHIPPEWA VALLEY TECHNICAL COLLEGE EAUC 67.45
1,733.32
X
X
Permit to raze garage. Both house and garage were erroneously removed from assessed value.
Wisconsin Department of RevenuePC-205 (N. 10-10) R614B
9
10
11
12
NO
- 2 -
Qualify for equalization test?
DEPARTMENT OF REVENUE DETERMINATION
If "NO", notify tax district clerk that no action will be taken.
YES If "YES", continue.
NOWould the If "NO", notify tax district clerk that no action will be taken.
YES If "YES", we will:
equalizedvalue have been different?
EITHER
OR
Adjust the equalized value by $
and the equalized value by $
Allow the sharing of the omitted taxes to the taxing jurisdictions.
Explanation of Determination:
Certify results and issue instructions to the clerks of the tax district.
2018
X
X
X
Request for Sharing of Non-Manufacturing Omitted Property Taxes
Wisconsin Department of RevenuePC-205 (N. 10-10) R614
See reverse side of form for DOR determination and explanation.
1
2
3
4
5
6
8
(Section 74.315, Wis. Stats.) DOR USE ONLY
Real Estate Parcel No.
Name of Property Owner
Real Estate
Year Tax Omitted
CASE NO.Town County Co Mun Code
TID # (if applicable):
Village City of
Omitted Assessed Value
Class(a)
Land(b)
Improvement(c)
Total (a + b)
Totals
Omitted Value
Net Omitted Taxes to be Shared With Taxing Jurisdictions - EXCLUDING INTEREST
a.
b.
c.1
c.2
d.
e.
f.
g.
h.
Code Name of Taxing Jurisdictions Net Tax
State of Wisconsin
County
Captured explanation.
Municipality (Local)
Total Net Tax Rescinded or Refunded - EXCLUDING INTEREST
Personal Property Account No.
Year added to Tax Roll
Personal Property
7 Was the omitted tax offset by a related corresponding adjustment?a.If Yes,provide:
Was a chargeback form (PC-201) filed for this related parcel/account number?b.
Parcel/Account No. Tax Amount
Yes No
Yes No
19 0011
2018 2019 X NORTH FOND DU LAC FOND DU LAC 20 161
X V051617321000500 001
SIDE X SIDE PROPERTIES LLC
2 .00 373,500.00 373,500.00
.00 373,500.00 373,500.00
.00 1,839.51
.00 .00
3,879.46 20 3983 SCH D OF NORTH FOND DU LAC 3,228.30 .00 00 1000 MORAINE PARK TECHNICAL COLLEGE FDLC 203.20
9,150.47
X
X
The Village of North Fond du Lac contracts with Bowmar Appraisal Inc. On January 1, 2018 the building was completed however Bowmar missed changing the improvements value of the building. The building remained at the 2017 value of $190,600 vs $564,100.
Wisconsin Department of RevenuePC-205 (N. 10-10) R614B
9
10
11
12
NO
- 2 -
Qualify for equalization test?
DEPARTMENT OF REVENUE DETERMINATION
If "NO", notify tax district clerk that no action will be taken.
YES If "YES", continue.
NOWould the If "NO", notify tax district clerk that no action will be taken.
YES If "YES", we will:
equalizedvalue have been different?
EITHER
OR
Adjust the equalized value by $
and the equalized value by $
Allow the sharing of the omitted taxes to the taxing jurisdictions.
Explanation of Determination:
Certify results and issue instructions to the clerks of the tax district.
2018
X
X
X
The omitted assessment is located in a TID. The error exists
in both the Equalized Value and TID value. In this TID the
error does not affect tax apportionment. Therefore the
omitted taxes collected do not need to be shared - PMG
Request for Sharing of Non-Manufacturing Omitted Property Taxes
Wisconsin Department of RevenuePC-205 (N. 10-10) R614
See reverse side of form for DOR determination and explanation.
1
2
3
4
5
6
8
(Section 74.315, Wis. Stats.) DOR USE ONLY
Real Estate Parcel No.
Name of Property Owner
Real Estate
Year Tax Omitted
CASE NO.Town County Co Mun Code
TID # (if applicable):
Village City of
Omitted Assessed Value
Class(a)
Land(b)
Improvement(c)
Total (a + b)
Totals
Omitted Value
Net Omitted Taxes to be Shared With Taxing Jurisdictions - EXCLUDING INTEREST
a.
b.
c.1
c.2
d.
e.
f.
g.
h.
Code Name of Taxing Jurisdictions Net Tax
State of Wisconsin
County
Captured explanation.
Municipality (Local)
Total Net Tax Rescinded or Refunded - EXCLUDING INTEREST
Personal Property Account No.
Year added to Tax Roll
Personal Property
7 Was the omitted tax offset by a related corresponding adjustment?a.If Yes,provide:
Was a chargeback form (PC-201) filed for this related parcel/account number?b.
Parcel/Account No. Tax Amount
Yes No
Yes No
19 0074
2017 2019 XWAUPUN FOND DU LAC 20 292
X WPN-14-15-99-FA-120-00
ROBERT AND RACHELLE HOPP
1 .00 210,500.00 210,500.00
.00 210,500.00 210,500.00
.00 1,169.63
.00 .00
1,543.98 20 6216 SCH D OF WAUPUN 1,966.67 .00 00 1000 MORAINE PARK TECHNICAL COLLEGE FDLC 128.94
4,809.22
X
X
The assessed value of the improvements of the newly constructed property was inadvertently omitted.
Wisconsin Department of RevenuePC-205 (N. 10-10) R614B
9
10
11
12
NO
- 2 -
Qualify for equalization test?
DEPARTMENT OF REVENUE DETERMINATION
If "NO", notify tax district clerk that no action will be taken.
YES If "YES", continue.
NOWould the If "NO", notify tax district clerk that no action will be taken.
YES If "YES", we will:
equalizedvalue have been different?
EITHER
OR
Adjust the equalized value by $
and the equalized value by $
Allow the sharing of the omitted taxes to the taxing jurisdictions.
Explanation of Determination:
Certify results and issue instructions to the clerks of the tax district.
2017
X
X
X
X
New construction was omitted from the assessment roll and
not included on the Municipal Assessment Report. Therefore
the Equalized Value was impacted. PMG
Request for Sharing of Non-Manufacturing Omitted Property Taxes
Wisconsin Department of RevenuePC-205 (N. 10-10) R614
See reverse side of form for DOR determination and explanation.
1
2
3
4
5
6
8
(Section 74.315, Wis. Stats.) DOR USE ONLY
Real Estate Parcel No.
Name of Property Owner
Real Estate
Year Tax Omitted
CASE NO.Town County Co Mun Code
TID # (if applicable):
Village City of
Omitted Assessed Value
Class(a)
Land(b)
Improvement(c)
Total (a + b)
Totals
Omitted Value
Net Omitted Taxes to be Shared With Taxing Jurisdictions - EXCLUDING INTEREST
a.
b.
c.1
c.2
d.
e.
f.
g.
h.
Code Name of Taxing Jurisdictions Net Tax
State of Wisconsin
County
Captured explanation.
Municipality (Local)
Total Net Tax Rescinded or Refunded - EXCLUDING INTEREST
Personal Property Account No.
Year added to Tax Roll
Personal Property
7 Was the omitted tax offset by a related corresponding adjustment?a.If Yes,provide:
Was a chargeback form (PC-201) filed for this related parcel/account number?b.
Parcel/Account No. Tax Amount
Yes No
Yes No
19 0075
2017 2019 XWAUPUN FOND DU LAC 20 292
X WPN-14-15-99-FA-430-00
MARK AND JEAN HOMAN
1 .00 411,500.00 411,500.00
.00 411,500.00 411,500.00
.00 2,286.48
.00 .00
3,018.28 20 6216 SCH D OF WAUPUN 3,844.57 .00 00 1000 MORAINE PARK TECHNICAL COLLEGE FDLC 252.07
9,401.40
X
X
The assessed value of the improvements of the newly constructed property was inadvertently omitted.
Wisconsin Department of RevenuePC-205 (N. 10-10) R614B
9
10
11
12
NO
- 2 -
Qualify for equalization test?
DEPARTMENT OF REVENUE DETERMINATION
If "NO", notify tax district clerk that no action will be taken.
YES If "YES", continue.
NOWould the If "NO", notify tax district clerk that no action will be taken.
YES If "YES", we will:
equalizedvalue have been different?
EITHER
OR
Adjust the equalized value by $
and the equalized value by $
Allow the sharing of the omitted taxes to the taxing jurisdictions.
Explanation of Determination:
Certify results and issue instructions to the clerks of the tax district.
2017
X
X
X
X
New construction was omitted from the assessment roll and
not included on the Municipal Assessment Report. Therefore
the Equalized Value was impacted. PMG
Request for Sharing of Non-Manufacturing Omitted Property Taxes
Wisconsin Department of RevenuePC-205 (N. 10-10) R614
See reverse side of form for DOR determination and explanation.
1
2
3
4
5
6
8
(Section 74.315, Wis. Stats.) DOR USE ONLY
Real Estate Parcel No.
Name of Property Owner
Real Estate
Year Tax Omitted
CASE NO.Town County Co Mun Code
TID # (if applicable):
Village City of
Omitted Assessed Value
Class(a)
Land(b)
Improvement(c)
Total (a + b)
Totals
Omitted Value
Net Omitted Taxes to be Shared With Taxing Jurisdictions - EXCLUDING INTEREST
a.
b.
c.1
c.2
d.
e.
f.
g.
h.
Code Name of Taxing Jurisdictions Net Tax
State of Wisconsin
County
Captured explanation.
Municipality (Local)
Total Net Tax Rescinded or Refunded - EXCLUDING INTEREST
Personal Property Account No.
Year added to Tax Roll
Personal Property
7 Was the omitted tax offset by a related corresponding adjustment?a.If Yes,provide:
Was a chargeback form (PC-201) filed for this related parcel/account number?b.
Parcel/Account No. Tax Amount
Yes No
Yes No
19 0076
2017 2019 XWAUPUN FOND DU LAC 20 292
X WPN-14-15-99-WO-120-00
CHRISTOPHER AND NICOLE JAHN
1 .00 242,300.00 242,300.00
.00 242,300.00 242,300.00
.00 1,346.33
.00 .00
1,777.23 20 6216 SCH D OF WAUPUN 2,263.77 .00 00 1000 MORAINE PARK TECHNICAL COLLEGE FDLC 148.42
5,535.75
X
X
The assessed value of the improvements of the newly constructed property was inadvertently omitted.
Wisconsin Department of RevenuePC-205 (N. 10-10) R614B
9
10
11
12
NO
- 2 -
Qualify for equalization test?
DEPARTMENT OF REVENUE DETERMINATION
If "NO", notify tax district clerk that no action will be taken.
YES If "YES", continue.
NOWould the If "NO", notify tax district clerk that no action will be taken.
YES If "YES", we will:
equalizedvalue have been different?
EITHER
OR
Adjust the equalized value by $
and the equalized value by $
Allow the sharing of the omitted taxes to the taxing jurisdictions.
Explanation of Determination:
Certify results and issue instructions to the clerks of the tax district.
2017
X
X
X
X
New construction was omitted from the assessment roll and
not included on the Municipal Assessment Report. Therefore
the Equalized Value was impacted. PMG
Request for Sharing of Non-Manufacturing Omitted Property Taxes
Wisconsin Department of RevenuePC-205 (N. 10-10) R614
See reverse side of form for DOR determination and explanation.
1
2
3
4
5
6
8
(Section 74.315, Wis. Stats.) DOR USE ONLY
Real Estate Parcel No.
Name of Property Owner
Real Estate
Year Tax Omitted
CASE NO.Town County Co Mun Code
TID # (if applicable):
Village City of
Omitted Assessed Value
Class(a)
Land(b)
Improvement(c)
Total (a + b)
Totals
Omitted Value
Net Omitted Taxes to be Shared With Taxing Jurisdictions - EXCLUDING INTEREST
a.
b.
c.1
c.2
d.
e.
f.
g.
h.
Code Name of Taxing Jurisdictions Net Tax
State of Wisconsin
County
Captured explanation.
Municipality (Local)
Total Net Tax Rescinded or Refunded - EXCLUDING INTEREST
Personal Property Account No.
Year added to Tax Roll
Personal Property
7 Was the omitted tax offset by a related corresponding adjustment?a.If Yes,provide:
Was a chargeback form (PC-201) filed for this related parcel/account number?b.
Parcel/Account No. Tax Amount
Yes No
Yes No
19 0049
2018 2019 XKENOSHA KENOSHA 30 241
X 01-122-01-155-008
DEBRA A LAWSON
1 .00 76,100.00 76,100.00
.00 76,100.00 76,100.00
.00 311.92
.00 .00
938.07 30 2793 SCH D OF KENOSHA 614.01 .00 00 0600 GATEWAY TECHNICAL COLLEGE KENO 52.75
1,916.75
X
X
Assessor error.
Wisconsin Department of RevenuePC-205 (N. 10-10) R614B
9
10
11
12
NO
- 2 -
Qualify for equalization test?
DEPARTMENT OF REVENUE DETERMINATION
If "NO", notify tax district clerk that no action will be taken.
YES If "YES", continue.
NOWould the If "NO", notify tax district clerk that no action will be taken.
YES If "YES", we will:
equalizedvalue have been different?
EITHER
OR
Adjust the equalized value by $
and the equalized value by $
Allow the sharing of the omitted taxes to the taxing jurisdictions.
Explanation of Determination:
Certify results and issue instructions to the clerks of the tax district.
2018
X
X
X
X
Existing real property was omitted for the current year and
previous year. Property omitted in the previous year's
assessment totals impacts the current year's economics
adjustments. Therefor the Equalized Value was affected.
Request for Sharing of Non-Manufacturing Omitted Property Taxes
Wisconsin Department of RevenuePC-205 (N. 10-10) R614
See reverse side of form for DOR determination and explanation.
1
2
3
4
5
6
8
(Section 74.315, Wis. Stats.) DOR USE ONLY
Real Estate Parcel No.
Name of Property Owner
Real Estate
Year Tax Omitted
CASE NO.Town County Co Mun Code
TID # (if applicable):
Village City of
Omitted Assessed Value
Class(a)
Land(b)
Improvement(c)
Total (a + b)
Totals
Omitted Value
Net Omitted Taxes to be Shared With Taxing Jurisdictions - EXCLUDING INTEREST
a.
b.
c.1
c.2
d.
e.
f.
g.
h.
Code Name of Taxing Jurisdictions Net Tax
State of Wisconsin
County
Captured explanation.
Municipality (Local)
Total Net Tax Rescinded or Refunded - EXCLUDING INTEREST
Personal Property Account No.
Year added to Tax Roll
Personal Property
7 Was the omitted tax offset by a related corresponding adjustment?a.If Yes,provide:
Was a chargeback form (PC-201) filed for this related parcel/account number?b.
Parcel/Account No. Tax Amount
Yes No
Yes No
19 0050
2018 2019 XKENOSHA KENOSHA 30 241
X 05-123-06-180-010
DAVID AND KELLY HAWKINS
1 32,700.00 158,700.00 191,400.00
32,700.00 158,700.00 191,400.00
.00 784.51
.00 .00
2,359.35 30 2793 SCH D OF KENOSHA 1,544.30 .00 00 0600 GATEWAY TECHNICAL COLLEGE KENO 132.68
4,820.84
X
X
Assessor error.
Wisconsin Department of RevenuePC-205 (N. 10-10) R614B
9
10
11
12
NO
- 2 -
Qualify for equalization test?
DEPARTMENT OF REVENUE DETERMINATION
If "NO", notify tax district clerk that no action will be taken.
YES If "YES", continue.
NOWould the If "NO", notify tax district clerk that no action will be taken.
YES If "YES", we will:
equalizedvalue have been different?
EITHER
OR
Adjust the equalized value by $
and the equalized value by $
Allow the sharing of the omitted taxes to the taxing jurisdictions.
Explanation of Determination:
Certify results and issue instructions to the clerks of the tax district.
2018
X
X
X
X
Existing real property was omitted for the current year and
previous year. Property omitted in the previous year's
assessment totals impacts the current year's economic
adjustments. Therefore the Equalized Value was affected.
Request for Sharing of Non-Manufacturing Omitted Property Taxes
Wisconsin Department of RevenuePC-205 (N. 10-10) R614
See reverse side of form for DOR determination and explanation.
1
2
3
4
5
6
8
(Section 74.315, Wis. Stats.) DOR USE ONLY
Real Estate Parcel No.
Name of Property Owner
Real Estate
Year Tax Omitted
CASE NO.Town County Co Mun Code
TID # (if applicable):
Village City of
Omitted Assessed Value
Class(a)
Land(b)
Improvement(c)
Total (a + b)
Totals
Omitted Value
Net Omitted Taxes to be Shared With Taxing Jurisdictions - EXCLUDING INTEREST
a.
b.
c.1
c.2
d.
e.
f.
g.
h.
Code Name of Taxing Jurisdictions Net Tax
State of Wisconsin
County
Captured explanation.
Municipality (Local)
Total Net Tax Rescinded or Refunded - EXCLUDING INTEREST
Personal Property Account No.
Year added to Tax Roll
Personal Property
7 Was the omitted tax offset by a related corresponding adjustment?a.If Yes,provide:
Was a chargeback form (PC-201) filed for this related parcel/account number?b.
Parcel/Account No. Tax Amount
Yes No
Yes No
19 0132
2017 2018 X LUXEMBURG KEWAUNEE 31 146
X 146-00070-0515
THOMAS WERNER
1 .00 217,300.00 217,300.00
.00 217,300.00 217,300.00
.00 1,281.55
05 5040 GREEN BAY METRO SEWER DISTRICT .00 .00
1,486.71 31 3220 SCH D OF LUXEMBURG-CASCO 1,414.23 .00 00 1300 NORTHEAST WISCONSIN TECH COLLEGE GNBY 146.63
4,329.12
X
X
It is my understanding the Assessor's did not do a full inspection of the property until after the error was found. The assessors stated that there was no bldg. permit, but the bldg. permit was filed in 10/2015. It seems that this home inspection slip through the cracks. After being informed by the property owner, in January of 2018; the Assessor reviewed the file and recognized that this property was not assessed
Wisconsin Department of RevenuePC-205 (N. 10-10) R614B
9
10
11
12
NO
- 2 -
Qualify for equalization test?
DEPARTMENT OF REVENUE DETERMINATION
If "NO", notify tax district clerk that no action will be taken.
YES If "YES", continue.
NOWould the If "NO", notify tax district clerk that no action will be taken.
YES If "YES", we will:
equalizedvalue have been different?
EITHER
OR
Adjust the equalized value by $
and the equalized value by $
Allow the sharing of the omitted taxes to the taxing jurisdictions.
Explanation of Determination:
Certify results and issue instructions to the clerks of the tax district.
2017
X
X
X
Request for Sharing of Non-Manufacturing Omitted Property Taxes
Wisconsin Department of RevenuePC-205 (N. 10-10) R614
See reverse side of form for DOR determination and explanation.
1
2
3
4
5
6
8
(Section 74.315, Wis. Stats.) DOR USE ONLY
Real Estate Parcel No.
Name of Property Owner
Real Estate
Year Tax Omitted
CASE NO.Town County Co Mun Code
TID # (if applicable):
Village City of
Omitted Assessed Value
Class(a)
Land(b)
Improvement(c)
Total (a + b)
Totals
Omitted Value
Net Omitted Taxes to be Shared With Taxing Jurisdictions - EXCLUDING INTEREST
a.
b.
c.1
c.2
d.
e.
f.
g.
h.
Code Name of Taxing Jurisdictions Net Tax
State of Wisconsin
County
Captured explanation.
Municipality (Local)
Total Net Tax Rescinded or Refunded - EXCLUDING INTEREST
Personal Property Account No.
Year added to Tax Roll
Personal Property
7 Was the omitted tax offset by a related corresponding adjustment?a.If Yes,provide:
Was a chargeback form (PC-201) filed for this related parcel/account number?b.
Parcel/Account No. Tax Amount
Yes No
Yes No
19 0041
2018 2019 XALGOMA KEWAUNEE 31 201
X201-05001-0965
MASONITE CORPORATION
.00 .00 .00
499,900.00
.00 3,458.27
.00 .00
5,820.45 31 0070 SCH D OF ALGOMA 4,400.62 .00 00 1300 NORTHEAST WISCONSIN TECH COLLEGE GNBY 403.95
14,083.29
X
X
Property switched from manufacturing to commercial. Our local assessor was under the impression they were leaving our City but they did not.
Wisconsin Department of RevenuePC-205 (N. 10-10) R614B
9
10
11
12
NO
- 2 -
Qualify for equalization test?
DEPARTMENT OF REVENUE DETERMINATION
If "NO", notify tax district clerk that no action will be taken.
YES If "YES", continue.
NOWould the If "NO", notify tax district clerk that no action will be taken.
YES If "YES", we will:
equalizedvalue have been different?
EITHER
OR
Adjust the equalized value by $
and the equalized value by $
Allow the sharing of the omitted taxes to the taxing jurisdictions.
Explanation of Determination:
Certify results and issue instructions to the clerks of the tax district.
2018
X
X
X
X
Personal property was omitted from the assessment roll and
not included on the Municipal Assessement Report. The
Equalized Value is impacted - PMG
Request for Sharing of Non-Manufacturing Omitted Property Taxes
Wisconsin Department of RevenuePC-205 (N. 10-10) R614
See reverse side of form for DOR determination and explanation.
1
2
3
4
5
6
8
(Section 74.315, Wis. Stats.) DOR USE ONLY
Real Estate Parcel No.
Name of Property Owner
Real Estate
Year Tax Omitted
CASE NO.Town County Co Mun Code
TID # (if applicable):
Village City of
Omitted Assessed Value
Class(a)
Land(b)
Improvement(c)
Total (a + b)
Totals
Omitted Value
Net Omitted Taxes to be Shared With Taxing Jurisdictions - EXCLUDING INTEREST
a.
b.
c.1
c.2
d.
e.
f.
g.
h.
Code Name of Taxing Jurisdictions Net Tax
State of Wisconsin
County
Captured explanation.
Municipality (Local)
Total Net Tax Rescinded or Refunded - EXCLUDING INTEREST
Personal Property Account No.
Year added to Tax Roll
Personal Property
7 Was the omitted tax offset by a related corresponding adjustment?a.If Yes,provide:
Was a chargeback form (PC-201) filed for this related parcel/account number?b.
Parcel/Account No. Tax Amount
Yes No
Yes No
19 0048
2018 2019 XWAUSAU MARATHON 37 291
X 291-2907-344-0878
ALLEN & SANDRA FLETCHER
1 12,000.00 10,000.00 22,000.00
12,000.00 10,000.00 22,000.00
.00 94.96
.00 .00
249.26 37 6223 SCH D OF WAUSAU 215.55 .00 00 1500 NORTH CENTRAL TECHNICAL COLLEGE WAUS 24.87
584.64
X
X
291-2907-344-0878 was a exempt parcel taken on Tax Deed and then resold in 8/2017 to a taxable identity. The shift to taxable was missed for the 2018 Roll. Palpable Error.There was no original property tax bill, due to being omitted, so there is no tax bill to attach.
Wisconsin Department of RevenuePC-205 (N. 10-10) R614B
9
10
11
12
NO
- 2 -
Qualify for equalization test?
DEPARTMENT OF REVENUE DETERMINATION
If "NO", notify tax district clerk that no action will be taken.
YES If "YES", continue.
NOWould the If "NO", notify tax district clerk that no action will be taken.
YES If "YES", we will:
equalizedvalue have been different?
EITHER
OR
Adjust the equalized value by $
and the equalized value by $
Allow the sharing of the omitted taxes to the taxing jurisdictions.
Explanation of Determination:
Certify results and issue instructions to the clerks of the tax district.
2018
X
X
X
Request for Sharing of Non-Manufacturing Omitted Property Taxes
Wisconsin Department of RevenuePC-205 (N. 10-10) R614
See reverse side of form for DOR determination and explanation.
1
2
3
4
5
6
8
(Section 74.315, Wis. Stats.) DOR USE ONLY
Real Estate Parcel No.
Name of Property Owner
Real Estate
Year Tax Omitted
CASE NO.Town County Co Mun Code
TID # (if applicable):
Village City of
Omitted Assessed Value
Class(a)
Land(b)
Improvement(c)
Total (a + b)
Totals
Omitted Value
Net Omitted Taxes to be Shared With Taxing Jurisdictions - EXCLUDING INTEREST
a.
b.
c.1
c.2
d.
e.
f.
g.
h.
Code Name of Taxing Jurisdictions Net Tax
State of Wisconsin
County
Captured explanation.
Municipality (Local)
Total Net Tax Rescinded or Refunded - EXCLUDING INTEREST
Personal Property Account No.
Year added to Tax Roll
Personal Property
7 Was the omitted tax offset by a related corresponding adjustment?a.If Yes,provide:
Was a chargeback form (PC-201) filed for this related parcel/account number?b.
Parcel/Account No. Tax Amount
Yes No
Yes No
19 0065
2018 2019 XOAK CREEK MILWAUKEE 40 265
X9999045610 011
BAYER HEALTHCARE LLC
.00 .00 .00
3,200.00
.00 13.78
40 5020 MILWAUKEE COUNTY METRO SEWER DISTRICT 4.76 .00
21.74 40 4018 SCH D OF OAK CREEK-FRANKLIN 23.88 .00 00 0900 MILWAUKEE AREA TECHNICAL COLLEGE MILW 3.44
67.60
X
X
PERSONAL PROPERTY FORM WAS NOT RECEIVED UNTIL AFTER 2018 BOARD OF REVIEW. ORIGINAL FORM SUBMITTED TO WRONG JURIDICITION (MILWAUKEE) FOR MARCH 1, 2018 DEADLINE
Wisconsin Department of RevenuePC-205 (N. 10-10) R614B
9
10
11
12
NO
- 2 -
Qualify for equalization test?
DEPARTMENT OF REVENUE DETERMINATION
If "NO", notify tax district clerk that no action will be taken.
YES If "YES", continue.
NOWould the If "NO", notify tax district clerk that no action will be taken.
YES If "YES", we will:
equalizedvalue have been different?
EITHER
OR
Adjust the equalized value by $
and the equalized value by $
Allow the sharing of the omitted taxes to the taxing jurisdictions.
Explanation of Determination:
Certify results and issue instructions to the clerks of the tax district.
2018
X
X
X
The omitted assessment is located on property in a TID. The
error exists in both the Equalized Value and the TID Value.
In this TID the error does not affect the apportionment of
taxes.The taxes collected do not need to be shared.
Request for Sharing of Non-Manufacturing Omitted Property Taxes
Wisconsin Department of RevenuePC-205 (N. 10-10) R614
See reverse side of form for DOR determination and explanation.
1
2
3
4
5
6
8
(Section 74.315, Wis. Stats.) DOR USE ONLY
Real Estate Parcel No.
Name of Property Owner
Real Estate
Year Tax Omitted
CASE NO.Town County Co Mun Code
TID # (if applicable):
Village City of
Omitted Assessed Value
Class(a)
Land(b)
Improvement(c)
Total (a + b)
Totals
Omitted Value
Net Omitted Taxes to be Shared With Taxing Jurisdictions - EXCLUDING INTEREST
a.
b.
c.1
c.2
d.
e.
f.
g.
h.
Code Name of Taxing Jurisdictions Net Tax
State of Wisconsin
County
Captured explanation.
Municipality (Local)
Total Net Tax Rescinded or Refunded - EXCLUDING INTEREST
Personal Property Account No.
Year added to Tax Roll
Personal Property
7 Was the omitted tax offset by a related corresponding adjustment?a.If Yes,provide:
Was a chargeback form (PC-201) filed for this related parcel/account number?b.
Parcel/Account No. Tax Amount
Yes No
Yes No
19 0066
2018 2019 XOAK CREEK MILWAUKEE 40 265
X9999070000
CAVE ENTERPRISES LLC
.00 .00 .00
5,400.00
.00 23.25
40 5020 MILWAUKEE COUNTY METRO SEWER DISTRICT 8.03 .00
36.68 40 4018 SCH D OF OAK CREEK-FRANKLIN 40.30 .00 00 0900 MILWAUKEE AREA TECHNICAL COLLEGE MILW 5.81
114.07
X
X
2018 FORM ERRONEOUSLY PROCESSED AS ALL MACHINERY, TOOLS AND PATTERNS FOR 2018. THE OMITTED VALUE IS FOR FURNITURE, FIXTURES
Wisconsin Department of RevenuePC-205 (N. 10-10) R614B
9
10
11
12
NO
- 2 -
Qualify for equalization test?
DEPARTMENT OF REVENUE DETERMINATION
If "NO", notify tax district clerk that no action will be taken.
YES If "YES", continue.
NOWould the If "NO", notify tax district clerk that no action will be taken.
YES If "YES", we will:
equalizedvalue have been different?
EITHER
OR
Adjust the equalized value by $
and the equalized value by $
Allow the sharing of the omitted taxes to the taxing jurisdictions.
Explanation of Determination:
Certify results and issue instructions to the clerks of the tax district.
2018
X
X
X
X
Personal property was omitted from the assessment roll and
not included on the Municipal Assessment report. The
Equalized Value is impacted.
Request for Sharing of Non-Manufacturing Omitted Property Taxes
Wisconsin Department of RevenuePC-205 (N. 10-10) R614
See reverse side of form for DOR determination and explanation.
1
2
3
4
5
6
8
(Section 74.315, Wis. Stats.) DOR USE ONLY
Real Estate Parcel No.
Name of Property Owner
Real Estate
Year Tax Omitted
CASE NO.Town County Co Mun Code
TID # (if applicable):
Village City of
Omitted Assessed Value
Class(a)
Land(b)
Improvement(c)
Total (a + b)
Totals
Omitted Value
Net Omitted Taxes to be Shared With Taxing Jurisdictions - EXCLUDING INTEREST
a.
b.
c.1
c.2
d.
e.
f.
g.
h.
Code Name of Taxing Jurisdictions Net Tax
State of Wisconsin
County
Captured explanation.
Municipality (Local)
Total Net Tax Rescinded or Refunded - EXCLUDING INTEREST
Personal Property Account No.
Year added to Tax Roll
Personal Property
7 Was the omitted tax offset by a related corresponding adjustment?a.If Yes,provide:
Was a chargeback form (PC-201) filed for this related parcel/account number?b.
Parcel/Account No. Tax Amount
Yes No
Yes No
19 0067
2018 2019 XOAK CREEK MILWAUKEE 40 265
X9999357401
SAFEMARK SYSTEMS LLC
.00 .00 .00
1,700.00
.00 7.32
40 5020 MILWAUKEE COUNTY METRO SEWER DISTRICT 2.53 .00
11.55 40 4018 SCH D OF OAK CREEK-FRANKLIN 12.69 .00 00 0900 MILWAUKEE AREA TECHNICAL COLLEGE MILW 1.83
35.92
X
X
2018 FORM ERRONEOUSLY PROCESSED AS ALL MACHINERY, TOOLS AND PATTERNS FOR 2018. THE OMITTED VALUE IS FOR FURNITURE, FIXTURES
Wisconsin Department of RevenuePC-205 (N. 10-10) R614B
9
10
11
12
NO
- 2 -
Qualify for equalization test?
DEPARTMENT OF REVENUE DETERMINATION
If "NO", notify tax district clerk that no action will be taken.
YES If "YES", continue.
NOWould the If "NO", notify tax district clerk that no action will be taken.
YES If "YES", we will:
equalizedvalue have been different?
EITHER
OR
Adjust the equalized value by $
and the equalized value by $
Allow the sharing of the omitted taxes to the taxing jurisdictions.
Explanation of Determination:
Certify results and issue instructions to the clerks of the tax district.
2018
X
X
X
X
Personal property was omitted from the assessment roll and
not included on the Municipal Assessment Report.
The Equalized Value is impacted.
Request for Sharing of Non-Manufacturing Omitted Property Taxes
Wisconsin Department of RevenuePC-205 (N. 10-10) R614
See reverse side of form for DOR determination and explanation.
1
2
3
4
5
6
8
(Section 74.315, Wis. Stats.) DOR USE ONLY
Real Estate Parcel No.
Name of Property Owner
Real Estate
Year Tax Omitted
CASE NO.Town County Co Mun Code
TID # (if applicable):
Village City of
Omitted Assessed Value
Class(a)
Land(b)
Improvement(c)
Total (a + b)
Totals
Omitted Value
Net Omitted Taxes to be Shared With Taxing Jurisdictions - EXCLUDING INTEREST
a.
b.
c.1
c.2
d.
e.
f.
g.
h.
Code Name of Taxing Jurisdictions Net Tax
State of Wisconsin
County
Captured explanation.
Municipality (Local)
Total Net Tax Rescinded or Refunded - EXCLUDING INTEREST
Personal Property Account No.
Year added to Tax Roll
Personal Property
7 Was the omitted tax offset by a related corresponding adjustment?a.If Yes,provide:
Was a chargeback form (PC-201) filed for this related parcel/account number?b.
Parcel/Account No. Tax Amount
Yes No
Yes No
19 0068
2018 2019 XOAK CREEK MILWAUKEE 40 265
X9999226300
KWIK TRIP INC NO 422
.00 .00 .00
165,600.00
.00 712.86
40 5020 MILWAUKEE COUNTY METRO SEWER DISTRICT 246.36 .00
1,124.80 40 4018 SCH D OF OAK CREEK-FRANKLIN 1,236.00 .00 00 0900 MILWAUKEE AREA TECHNICAL COLLEGE MILW 178.14
3,498.16
X
X
2018 FORM ERRONEOUSLY PROCESSED AS ALL MACHINERY, TOOLS AND PATTERNS FOR 2018. THE OMITTED VALUE IS FOR FURNITURE, FIXTURES
Wisconsin Department of RevenuePC-205 (N. 10-10) R614B
9
10
11
12
NO
- 2 -
Qualify for equalization test?
DEPARTMENT OF REVENUE DETERMINATION
If "NO", notify tax district clerk that no action will be taken.
YES If "YES", continue.
NOWould the If "NO", notify tax district clerk that no action will be taken.
YES If "YES", we will:
equalizedvalue have been different?
EITHER
OR
Adjust the equalized value by $
and the equalized value by $
Allow the sharing of the omitted taxes to the taxing jurisdictions.
Explanation of Determination:
Certify results and issue instructions to the clerks of the tax district.
2018
X
X
X
X
Personal property was omitted from the assessment roll and
not included on the Municipal Assessment Report.
The Equalized Value is impacted.
Request for Sharing of Non-Manufacturing Omitted Property Taxes
Wisconsin Department of RevenuePC-205 (N. 10-10) R614
See reverse side of form for DOR determination and explanation.
1
2
3
4
5
6
8
(Section 74.315, Wis. Stats.) DOR USE ONLY
Real Estate Parcel No.
Name of Property Owner
Real Estate
Year Tax Omitted
CASE NO.Town County Co Mun Code
TID # (if applicable):
Village City of
Omitted Assessed Value
Class(a)
Land(b)
Improvement(c)
Total (a + b)
Totals
Omitted Value
Net Omitted Taxes to be Shared With Taxing Jurisdictions - EXCLUDING INTEREST
a.
b.
c.1
c.2
d.
e.
f.
g.
h.
Code Name of Taxing Jurisdictions Net Tax
State of Wisconsin
County
Captured explanation.
Municipality (Local)
Total Net Tax Rescinded or Refunded - EXCLUDING INTEREST
Personal Property Account No.
Year added to Tax Roll
Personal Property
7 Was the omitted tax offset by a related corresponding adjustment?a.If Yes,provide:
Was a chargeback form (PC-201) filed for this related parcel/account number?b.
Parcel/Account No. Tax Amount
Yes No
Yes No
19 0069
2018 2019 XOAK CREEK MILWAUKEE 40 265
X 9259993000
ROBERT & SUSAN GRAMS
2 73,200.00 262,600.00 335,800.00
73,200.00 262,600.00 335,800.00
.00 1,445.52
40 5020 MILWAUKEE COUNTY METRO SEWER DISTRICT 499.56 .00
2,280.85 40 4018 SCH D OF OAK CREEK-FRANKLIN 2,506.34 .00 00 0900 MILWAUKEE AREA TECHNICAL COLLEGE MILW 361.23
7,093.50
X
X
PROPERTY WAS STATE ASSESSED FOR 2017 AND SHOULD HAVE BEEN TRANSFERRED TO LOCAL ASSESSED FOR 2018. ASSESSORS OFFICE DID NOT PROCESS PROPERLY, NO LOCAL ASSESSMENT ENTERED FOR 2018
Wisconsin Department of RevenuePC-205 (N. 10-10) R614B
9
10
11
12
NO
- 2 -
Qualify for equalization test?
DEPARTMENT OF REVENUE DETERMINATION
If "NO", notify tax district clerk that no action will be taken.
YES If "YES", continue.
NOWould the If "NO", notify tax district clerk that no action will be taken.
YES If "YES", we will:
equalizedvalue have been different?
EITHER
OR
Adjust the equalized value by $
and the equalized value by $
Allow the sharing of the omitted taxes to the taxing jurisdictions.
Explanation of Determination:
Certify results and issue instructions to the clerks of the tax district.
2018
X
X
X
X
A Manufacturing assesssment was omitted from the assessment
roll and was not included in values provided for Equalized
Value. The omitted assessment was not corrected by an
adjustment.
Request for Sharing of Non-Manufacturing Omitted Property Taxes
Wisconsin Department of RevenuePC-205 (N. 10-10) R614
See reverse side of form for DOR determination and explanation.
1
2
3
4
5
6
8
(Section 74.315, Wis. Stats.) DOR USE ONLY
Real Estate Parcel No.
Name of Property Owner
Real Estate
Year Tax Omitted
CASE NO.Town County Co Mun Code
TID # (if applicable):
Village City of
Omitted Assessed Value
Class(a)
Land(b)
Improvement(c)
Total (a + b)
Totals
Omitted Value
Net Omitted Taxes to be Shared With Taxing Jurisdictions - EXCLUDING INTEREST
a.
b.
c.1
c.2
d.
e.
f.
g.
h.
Code Name of Taxing Jurisdictions Net Tax
State of Wisconsin
County
Captured explanation.
Municipality (Local)
Total Net Tax Rescinded or Refunded - EXCLUDING INTEREST
Personal Property Account No.
Year added to Tax Roll
Personal Property
7 Was the omitted tax offset by a related corresponding adjustment?a.If Yes,provide:
Was a chargeback form (PC-201) filed for this related parcel/account number?b.
Parcel/Account No. Tax Amount
Yes No
Yes No
19 0070
2018 2019 XOAK CREEK MILWAUKEE 40 265
X 9039041000 007
TRI-WIRE LLC
2 350,900.00 723,600.00 1,074,500.00
350,900.00 723,600.00 1,074,500.00
.00 4,625.42
40 5020 MILWAUKEE COUNTY METRO SEWER DISTRICT 1,598.50 .00
7,298.30 40 4018 SCH D OF OAK CREEK-FRANKLIN 8,019.85 .00 00 0900 MILWAUKEE AREA TECHNICAL COLLEGE MILW 1,155.88
22,697.95
X
X
PROPERTY WAS STATE ASSESSED FOR 2017 AND SHOULD HAVE BEEN TRANSFERRED TO LOCAL ASSESSED FOR 2018. ASSESSORS OFFICE DID NOT PROCESS PROPERLY, NO LOCAL ASSESSMENT ENTERED FOR 2018
Wisconsin Department of RevenuePC-205 (N. 10-10) R614B
9
10
11
12
NO
- 2 -
Qualify for equalization test?
DEPARTMENT OF REVENUE DETERMINATION
If "NO", notify tax district clerk that no action will be taken.
YES If "YES", continue.
NOWould the If "NO", notify tax district clerk that no action will be taken.
YES If "YES", we will:
equalizedvalue have been different?
EITHER
OR
Adjust the equalized value by $
and the equalized value by $
Allow the sharing of the omitted taxes to the taxing jurisdictions.
Explanation of Determination:
Certify results and issue instructions to the clerks of the tax district.
2018
X
X
X
The omitted assessment is located on property in a TID. The
error exists in both the Equalized Value and the TID Value.
In this TID the error does not affect the apportionment of
taxes. The taxes collected do not need to be shared.
Request for Sharing of Non-Manufacturing Omitted Property Taxes
Wisconsin Department of RevenuePC-205 (N. 10-10) R614
See reverse side of form for DOR determination and explanation.
1
2
3
4
5
6
8
(Section 74.315, Wis. Stats.) DOR USE ONLY
Real Estate Parcel No.
Name of Property Owner
Real Estate
Year Tax Omitted
CASE NO.Town County Co Mun Code
TID # (if applicable):
Village City of
Omitted Assessed Value
Class(a)
Land(b)
Improvement(c)
Total (a + b)
Totals
Omitted Value
Net Omitted Taxes to be Shared With Taxing Jurisdictions - EXCLUDING INTEREST
a.
b.
c.1
c.2
d.
e.
f.
g.
h.
Code Name of Taxing Jurisdictions Net Tax
State of Wisconsin
County
Captured explanation.
Municipality (Local)
Total Net Tax Rescinded or Refunded - EXCLUDING INTEREST
Personal Property Account No.
Year added to Tax Roll
Personal Property
7 Was the omitted tax offset by a related corresponding adjustment?a.If Yes,provide:
Was a chargeback form (PC-201) filed for this related parcel/account number?b.
Parcel/Account No. Tax Amount
Yes No
Yes No
19 0087
2018 2019 XOAK CREEK MILWAUKEE 40 265
X9999124051 011
BARRETT VISIONARY DEVELOPMENT
.00 .00 .00
142,100.00
.00 611.70
40 5020 MILWAUKEE COUNTY METRO SEWER DISTRICT 211.40 .00
965.18 40 4018 SCH D OF OAK CREEK-FRANKLIN 1,060.61 .00 00 0900 MILWAUKEE AREA TECHNICAL COLLEGE MILW 152.86
3,001.75
X
X
New building was picked up for real estate, but not for the personal property account.
Wisconsin Department of RevenuePC-205 (N. 10-10) R614B
9
10
11
12
NO
- 2 -
Qualify for equalization test?
DEPARTMENT OF REVENUE DETERMINATION
If "NO", notify tax district clerk that no action will be taken.
YES If "YES", continue.
NOWould the If "NO", notify tax district clerk that no action will be taken.
YES If "YES", we will:
equalizedvalue have been different?
EITHER
OR
Adjust the equalized value by $
and the equalized value by $
Allow the sharing of the omitted taxes to the taxing jurisdictions.
Explanation of Determination:
Certify results and issue instructions to the clerks of the tax district.
2018
X
X
X
The omitted assessment is located on property in a TID. The
error exists in both the Equalized Value and the TID Value.
In this TID the error does not affect the apportionment of
taxes. The taxes collected do not need to be shared.
Request for Sharing of Non-Manufacturing Omitted Property Taxes
Wisconsin Department of RevenuePC-205 (N. 10-10) R614
See reverse side of form for DOR determination and explanation.
1
2
3
4
5
6
8
(Section 74.315, Wis. Stats.) DOR USE ONLY
Real Estate Parcel No.
Name of Property Owner
Real Estate
Year Tax Omitted
CASE NO.Town County Co Mun Code
TID # (if applicable):
Village City of
Omitted Assessed Value
Class(a)
Land(b)
Improvement(c)
Total (a + b)
Totals
Omitted Value
Net Omitted Taxes to be Shared With Taxing Jurisdictions - EXCLUDING INTEREST
a.
b.
c.1
c.2
d.
e.
f.
g.
h.
Code Name of Taxing Jurisdictions Net Tax
State of Wisconsin
County
Captured explanation.
Municipality (Local)
Total Net Tax Rescinded or Refunded - EXCLUDING INTEREST
Personal Property Account No.
Year added to Tax Roll
Personal Property
7 Was the omitted tax offset by a related corresponding adjustment?a.If Yes,provide:
Was a chargeback form (PC-201) filed for this related parcel/account number?b.
Parcel/Account No. Tax Amount
Yes No
Yes No
19 0199
2017 2018 XWEST ALLIS MILWAUKEE 40 292
X26432
ADELANTE MEDIA GROUP
.00 .00 .00
23,300.00
.00 106.95
40 5020 MILWAUKEE COUNTY METRO SEWER DISTRICT 36.52 .00
256.21 40 6300 SCH D OF WEST ALLIS 232.58 .00 00 0900 MILWAUKEE AREA TECHNICAL COLLEGE MILW 26.61
658.87
X
X
The property was inactivated in the past, but during the 2018 personal property occupancy inspection, it was discovered.
Wisconsin Department of RevenuePC-205 (N. 10-10) R614B
9
10
11
12
NO
- 2 -
Qualify for equalization test?
DEPARTMENT OF REVENUE DETERMINATION
If "NO", notify tax district clerk that no action will be taken.
YES If "YES", continue.
NOWould the If "NO", notify tax district clerk that no action will be taken.
YES If "YES", we will:
equalizedvalue have been different?
EITHER
OR
Adjust the equalized value by $
and the equalized value by $
Allow the sharing of the omitted taxes to the taxing jurisdictions.
Explanation of Determination:
Certify results and issue instructions to the clerks of the tax district.
2017
X
X
X
Request for Sharing of Non-Manufacturing Omitted Property Taxes
Wisconsin Department of RevenuePC-205 (N. 10-10) R614
See reverse side of form for DOR determination and explanation.
1
2
3
4
5
6
8
(Section 74.315, Wis. Stats.) DOR USE ONLY
Real Estate Parcel No.
Name of Property Owner
Real Estate
Year Tax Omitted
CASE NO.Town County Co Mun Code
TID # (if applicable):
Village City of
Omitted Assessed Value
Class(a)
Land(b)
Improvement(c)
Total (a + b)
Totals
Omitted Value
Net Omitted Taxes to be Shared With Taxing Jurisdictions - EXCLUDING INTEREST
a.
b.
c.1
c.2
d.
e.
f.
g.
h.
Code Name of Taxing Jurisdictions Net Tax
State of Wisconsin
County
Captured explanation.
Municipality (Local)
Total Net Tax Rescinded or Refunded - EXCLUDING INTEREST
Personal Property Account No.
Year added to Tax Roll
Personal Property
7 Was the omitted tax offset by a related corresponding adjustment?a.If Yes,provide:
Was a chargeback form (PC-201) filed for this related parcel/account number?b.
Parcel/Account No. Tax Amount
Yes No
Yes No
19 0045
2017 2018X LAKEWOOD OCONTO 42 019
X 019101001733B
JAMES W BUDZINSKI
1 42,000.00 .00 42,000.00
42,000.00 .00 42,000.00
.00 191.07
.00 .00
122.43 21 5992 SCH D OF WABENO AREA 266.46 .00 00 1300 NORTHEAST WISCONSIN TECH COLLEGE GNBY 31.03
610.99
X
X
S495'OF SWSW &PRT NWNW & NENW SEC15 AS DES IN V1261-P839. 1197-379 1261-839 602393 Plat 10 33 N 16 E 15.78 total acres 15.0 were in MFL and fell from 2017 MFL creating an omitted tax.
Wisconsin Department of RevenuePC-205 (N. 10-10) R614B
9
10
11
12
NO
- 2 -
Qualify for equalization test?
DEPARTMENT OF REVENUE DETERMINATION
If "NO", notify tax district clerk that no action will be taken.
YES If "YES", continue.
NOWould the If "NO", notify tax district clerk that no action will be taken.
YES If "YES", we will:
equalizedvalue have been different?
EITHER
OR
Adjust the equalized value by $
and the equalized value by $
Allow the sharing of the omitted taxes to the taxing jurisdictions.
Explanation of Determination:
Certify results and issue instructions to the clerks of the tax district.
2017
X
X
X
Request for Sharing of Non-Manufacturing Omitted Property Taxes
Wisconsin Department of RevenuePC-205 (N. 10-10) R614
See reverse side of form for DOR determination and explanation.
1
2
3
4
5
6
8
(Section 74.315, Wis. Stats.) DOR USE ONLY
Real Estate Parcel No.
Name of Property Owner
Real Estate
Year Tax Omitted
CASE NO.Town County Co Mun Code
TID # (if applicable):
Village City of
Omitted Assessed Value
Class(a)
Land(b)
Improvement(c)
Total (a + b)
Totals
Omitted Value
Net Omitted Taxes to be Shared With Taxing Jurisdictions - EXCLUDING INTEREST
a.
b.
c.1
c.2
d.
e.
f.
g.
h.
Code Name of Taxing Jurisdictions Net Tax
State of Wisconsin
County
Captured explanation.
Municipality (Local)
Total Net Tax Rescinded or Refunded - EXCLUDING INTEREST
Personal Property Account No.
Year added to Tax Roll
Personal Property
7 Was the omitted tax offset by a related corresponding adjustment?a.If Yes,provide:
Was a chargeback form (PC-201) filed for this related parcel/account number?b.
Parcel/Account No. Tax Amount
Yes No
Yes No
19 0098
2018 2019X GRAND CHUTE OUTAGAMIE 44 020
X10099245000
MODERN BUSINESS
.00 .00 .00
41,100.00
.00 197.25
44 7050 GRAND CHUTE SANITARY DISTRICT #1 9.30 .00
205.77 44 0147 SCH D OF APPLETON AREA 347.69 .00 00 1200 FOX VALLEY TECHNICAL COLLEGE APPL 42.34
802.35
X
X
Originally received two forms, one at later date. We thought it was an amendment instead of separate new account
Wisconsin Department of RevenuePC-205 (N. 10-10) R614B
9
10
11
12
NO
- 2 -
Qualify for equalization test?
DEPARTMENT OF REVENUE DETERMINATION
If "NO", notify tax district clerk that no action will be taken.
YES If "YES", continue.
NOWould the If "NO", notify tax district clerk that no action will be taken.
YES If "YES", we will:
equalizedvalue have been different?
EITHER
OR
Adjust the equalized value by $
and the equalized value by $
Allow the sharing of the omitted taxes to the taxing jurisdictions.
Explanation of Determination:
Certify results and issue instructions to the clerks of the tax district.
2018
X
X
X
Request for Sharing of Non-Manufacturing Omitted Property Taxes
Wisconsin Department of RevenuePC-205 (N. 10-10) R614
See reverse side of form for DOR determination and explanation.
1
2
3
4
5
6
8
(Section 74.315, Wis. Stats.) DOR USE ONLY
Real Estate Parcel No.
Name of Property Owner
Real Estate
Year Tax Omitted
CASE NO.Town County Co Mun Code
TID # (if applicable):
Village City of
Omitted Assessed Value
Class(a)
Land(b)
Improvement(c)
Total (a + b)
Totals
Omitted Value
Net Omitted Taxes to be Shared With Taxing Jurisdictions - EXCLUDING INTEREST
a.
b.
c.1
c.2
d.
e.
f.
g.
h.
Code Name of Taxing Jurisdictions Net Tax
State of Wisconsin
County
Captured explanation.
Municipality (Local)
Total Net Tax Rescinded or Refunded - EXCLUDING INTEREST
Personal Property Account No.
Year added to Tax Roll
Personal Property
7 Was the omitted tax offset by a related corresponding adjustment?a.If Yes,provide:
Was a chargeback form (PC-201) filed for this related parcel/account number?b.
Parcel/Account No. Tax Amount
Yes No
Yes No
19 0099
2018 2019X GRAND CHUTE OUTAGAMIE 44 020
X 101158200
LAWRENCE PETERSON REVOC TRUST
6 1,000.00 .00 1,000.00 5 1,000.00 .00 1,000.00 4 6,200.00 .00 6,200.00
8,200.00 .00 8,200.00
.00 39.35
44 7050 GRAND CHUTE SANITARY DISTRICT #1 1.86 .00
41.05 44 0147 SCH D OF APPLETON AREA 69.37 .00 00 1200 FOX VALLEY TECHNICAL COLLEGE APPL 8.45
160.08
X
X
In 2017 there was a transaction with this parcel and the City of Appleton. The transaction was processed as a 100% acquirement with the City of Appleton when in fact it was a partial acquisition. This remnant which was not transferred was listed as Exempt City owned.
Wisconsin Department of RevenuePC-205 (N. 10-10) R614B
9
10
11
12
NO
- 2 -
Qualify for equalization test?
DEPARTMENT OF REVENUE DETERMINATION
If "NO", notify tax district clerk that no action will be taken.
YES If "YES", continue.
NOWould the If "NO", notify tax district clerk that no action will be taken.
YES If "YES", we will:
equalizedvalue have been different?
EITHER
OR
Adjust the equalized value by $
and the equalized value by $
Allow the sharing of the omitted taxes to the taxing jurisdictions.
Explanation of Determination:
Certify results and issue instructions to the clerks of the tax district.
2018
X
X
X
Request for Sharing of Non-Manufacturing Omitted Property Taxes
Wisconsin Department of RevenuePC-205 (N. 10-10) R614
See reverse side of form for DOR determination and explanation.
1
2
3
4
5
6
8
(Section 74.315, Wis. Stats.) DOR USE ONLY
Real Estate Parcel No.
Name of Property Owner
Real Estate
Year Tax Omitted
CASE NO.Town County Co Mun Code
TID # (if applicable):
Village City of
Omitted Assessed Value
Class(a)
Land(b)
Improvement(c)
Total (a + b)
Totals
Omitted Value
Net Omitted Taxes to be Shared With Taxing Jurisdictions - EXCLUDING INTEREST
a.
b.
c.1
c.2
d.
e.
f.
g.
h.
Code Name of Taxing Jurisdictions Net Tax
State of Wisconsin
County
Captured explanation.
Municipality (Local)
Total Net Tax Rescinded or Refunded - EXCLUDING INTEREST
Personal Property Account No.
Year added to Tax Roll
Personal Property
7 Was the omitted tax offset by a related corresponding adjustment?a.If Yes,provide:
Was a chargeback form (PC-201) filed for this related parcel/account number?b.
Parcel/Account No. Tax Amount
Yes No
Yes No
19 0100
2018 2019X GRAND CHUTE OUTAGAMIE 44 020
X10099361190 002
UNISON CREDIT UNION
.00 .00 .00
149,100.00
.00 715.56
44 7050 GRAND CHUTE SANITARY DISTRICT #1 33.75 .00
746.48 44 0147 SCH D OF APPLETON AREA 1,261.31 .00 00 1200 FOX VALLEY TECHNICAL COLLEGE APPL 153.61
2,910.71
X
X
A personal property form was received but was processed by the Assessor's Office as not being in the Town as of January 1, 2018. Further research after BOR 2018 showed the assets were in the Town as of January 1, 2018 and should have been assessed for 2018.
Wisconsin Department of RevenuePC-205 (N. 10-10) R614B
9
10
11
12
NO
- 2 -
Qualify for equalization test?
DEPARTMENT OF REVENUE DETERMINATION
If "NO", notify tax district clerk that no action will be taken.
YES If "YES", continue.
NOWould the If "NO", notify tax district clerk that no action will be taken.
YES If "YES", we will:
equalizedvalue have been different?
EITHER
OR
Adjust the equalized value by $
and the equalized value by $
Allow the sharing of the omitted taxes to the taxing jurisdictions.
Explanation of Determination:
Certify results and issue instructions to the clerks of the tax district.
2018
X
X
X
Request for Sharing of Non-Manufacturing Omitted Property Taxes
Wisconsin Department of RevenuePC-205 (N. 10-10) R614
See reverse side of form for DOR determination and explanation.
1
2
3
4
5
6
8
(Section 74.315, Wis. Stats.) DOR USE ONLY
Real Estate Parcel No.
Name of Property Owner
Real Estate
Year Tax Omitted
CASE NO.Town County Co Mun Code
TID # (if applicable):
Village City of
Omitted Assessed Value
Class(a)
Land(b)
Improvement(c)
Total (a + b)
Totals
Omitted Value
Net Omitted Taxes to be Shared With Taxing Jurisdictions - EXCLUDING INTEREST
a.
b.
c.1
c.2
d.
e.
f.
g.
h.
Code Name of Taxing Jurisdictions Net Tax
State of Wisconsin
County
Captured explanation.
Municipality (Local)
Total Net Tax Rescinded or Refunded - EXCLUDING INTEREST
Personal Property Account No.
Year added to Tax Roll
Personal Property
7 Was the omitted tax offset by a related corresponding adjustment?a.If Yes,provide:
Was a chargeback form (PC-201) filed for this related parcel/account number?b.
Parcel/Account No. Tax Amount
Yes No
Yes No
19 0101
2018 2019X GRAND CHUTE OUTAGAMIE 44 020
X10099129450
FINISHMASTER INC
.00 .00 .00
4,950.00
.00 23.76
44 7050 GRAND CHUTE SANITARY DISTRICT #1 1.12 .00
24.78 44 0147 SCH D OF APPLETON AREA 41.87 .00 00 1200 FOX VALLEY TECHNICAL COLLEGE APPL 5.10
96.63
X
X
2018 personal property return received by Assessor's Office just before tax bills printed in December 2018. The assets were determined to be in the Town as as January 1, 2018 and that if received timely, a 2018 assessment would have been created.
Wisconsin Department of RevenuePC-205 (N. 10-10) R614B
9
10
11
12
NO
- 2 -
Qualify for equalization test?
DEPARTMENT OF REVENUE DETERMINATION
If "NO", notify tax district clerk that no action will be taken.
YES If "YES", continue.
NOWould the If "NO", notify tax district clerk that no action will be taken.
YES If "YES", we will:
equalizedvalue have been different?
EITHER
OR
Adjust the equalized value by $
and the equalized value by $
Allow the sharing of the omitted taxes to the taxing jurisdictions.
Explanation of Determination:
Certify results and issue instructions to the clerks of the tax district.
2018
X
X
X
Request for Sharing of Non-Manufacturing Omitted Property Taxes
Wisconsin Department of RevenuePC-205 (N. 10-10) R614
See reverse side of form for DOR determination and explanation.
1
2
3
4
5
6
8
(Section 74.315, Wis. Stats.) DOR USE ONLY
Real Estate Parcel No.
Name of Property Owner
Real Estate
Year Tax Omitted
CASE NO.Town County Co Mun Code
TID # (if applicable):
Village City of
Omitted Assessed Value
Class(a)
Land(b)
Improvement(c)
Total (a + b)
Totals
Omitted Value
Net Omitted Taxes to be Shared With Taxing Jurisdictions - EXCLUDING INTEREST
a.
b.
c.1
c.2
d.
e.
f.
g.
h.
Code Name of Taxing Jurisdictions Net Tax
State of Wisconsin
County
Captured explanation.
Municipality (Local)
Total Net Tax Rescinded or Refunded - EXCLUDING INTEREST
Personal Property Account No.
Year added to Tax Roll
Personal Property
7 Was the omitted tax offset by a related corresponding adjustment?a.If Yes,provide:
Was a chargeback form (PC-201) filed for this related parcel/account number?b.
Parcel/Account No. Tax Amount
Yes No
Yes No
19 0084
2017 2019X DOVER RACINE 51 006
X 006032005021000
JAMES W CARLSON
1 .00 369,200.00 369,200.00
.00 369,200.00 369,200.00
.00 1,362.71
.00 .00
690.66 51 6113 SCH D OF WATERFORD GRADED J 1 (V) 2,676.10 51 6083 UHS D OF WATERFORD UNION HIGH 1,447.04 00 0600 GATEWAY TECHNICAL COLLEGE KENO 281.99
6,458.50
X
X
A new home was built on this parcel which was previously unimproved.
Wisconsin Department of RevenuePC-205 (N. 10-10) R614B
9
10
11
12
NO
- 2 -
Qualify for equalization test?
DEPARTMENT OF REVENUE DETERMINATION
If "NO", notify tax district clerk that no action will be taken.
YES If "YES", continue.
NOWould the If "NO", notify tax district clerk that no action will be taken.
YES If "YES", we will:
equalizedvalue have been different?
EITHER
OR
Adjust the equalized value by $
and the equalized value by $
Allow the sharing of the omitted taxes to the taxing jurisdictions.
Explanation of Determination:
Certify results and issue instructions to the clerks of the tax district.
2017
X
X
X
X
New construction was omitted from the assessment roll and
not included on the Municipal Assessment Report. Therefore
the Equalized Value was impacted.
Request for Sharing of Non-Manufacturing Omitted Property Taxes
Wisconsin Department of RevenuePC-205 (N. 10-10) R614
See reverse side of form for DOR determination and explanation.
1
2
3
4
5
6
8
(Section 74.315, Wis. Stats.) DOR USE ONLY
Real Estate Parcel No.
Name of Property Owner
Real Estate
Year Tax Omitted
CASE NO.Town County Co Mun Code
TID # (if applicable):
Village City of
Omitted Assessed Value
Class(a)
Land(b)
Improvement(c)
Total (a + b)
Totals
Omitted Value
Net Omitted Taxes to be Shared With Taxing Jurisdictions - EXCLUDING INTEREST
a.
b.
c.1
c.2
d.
e.
f.
g.
h.
Code Name of Taxing Jurisdictions Net Tax
State of Wisconsin
County
Captured explanation.
Municipality (Local)
Total Net Tax Rescinded or Refunded - EXCLUDING INTEREST
Personal Property Account No.
Year added to Tax Roll
Personal Property
7 Was the omitted tax offset by a related corresponding adjustment?a.If Yes,provide:
Was a chargeback form (PC-201) filed for this related parcel/account number?b.
Parcel/Account No. Tax Amount
Yes No
Yes No
19 0086
2018 2019X DOVER RACINE 51 006
X 006-03-20-05-021-000
JAMES W CARLSON
1 .00 369,200.00 369,200.00
.00 369,200.00 369,200.00
.00 1,342.00
.00 .00
688.06 51 6113 SCH D OF WATERFORD GRADED J 1 (V) 2,683.69 51 6083 UHS D OF WATERFORD UNION HIGH 1,451.08 00 0600 GATEWAY TECHNICAL COLLEGE KENO 284.05
6,448.88
X
X
A house was built on a previously unimproved parcel.
Wisconsin Department of RevenuePC-205 (N. 10-10) R614B
9
10
11
12
NO
- 2 -
Qualify for equalization test?
DEPARTMENT OF REVENUE DETERMINATION
If "NO", notify tax district clerk that no action will be taken.
YES If "YES", continue.
NOWould the If "NO", notify tax district clerk that no action will be taken.
YES If "YES", we will:
equalizedvalue have been different?
EITHER
OR
Adjust the equalized value by $
and the equalized value by $
Allow the sharing of the omitted taxes to the taxing jurisdictions.
Explanation of Determination:
Certify results and issue instructions to the clerks of the tax district.
2018
X
X
X
X
New Construction was omitted from the assessment roll and
not included on the Municipal Assessment Report. Therefore
the Equalized Value was impacted.
Request for Sharing of Non-Manufacturing Omitted Property Taxes
Wisconsin Department of RevenuePC-205 (N. 10-10) R614
See reverse side of form for DOR determination and explanation.
1
2
3
4
5
6
8
(Section 74.315, Wis. Stats.) DOR USE ONLY
Real Estate Parcel No.
Name of Property Owner
Real Estate
Year Tax Omitted
CASE NO.Town County Co Mun Code
TID # (if applicable):
Village City of
Omitted Assessed Value
Class(a)
Land(b)
Improvement(c)
Total (a + b)
Totals
Omitted Value
Net Omitted Taxes to be Shared With Taxing Jurisdictions - EXCLUDING INTEREST
a.
b.
c.1
c.2
d.
e.
f.
g.
h.
Code Name of Taxing Jurisdictions Net Tax
State of Wisconsin
County
Captured explanation.
Municipality (Local)
Total Net Tax Rescinded or Refunded - EXCLUDING INTEREST
Personal Property Account No.
Year added to Tax Roll
Personal Property
7 Was the omitted tax offset by a related corresponding adjustment?a.If Yes,provide:
Was a chargeback form (PC-201) filed for this related parcel/account number?b.
Parcel/Account No. Tax Amount
Yes No
Yes No
19 0103
2018 2019X GREENBUSH SHEBOYGAN 59 002
X 59002011264
SCOTT R AND KRYSTAL K GUENTHER
1 .00 273,200.00 273,200.00
.00 273,200.00 273,200.00
.00 1,433.66
.00 .00
236.21 59 1631 SCH D OF ELKHART LAKE-GLENBEULAH 1,868.37 .00 00 1100 LAKESHORE TECHNICAL COLLEGE CLEV 205.96
3,744.20
X
X
Assessor did not include new construction on the 2018 assessment roll.
Wisconsin Department of RevenuePC-205 (N. 10-10) R614B
9
10
11
12
NO
- 2 -
Qualify for equalization test?
DEPARTMENT OF REVENUE DETERMINATION
If "NO", notify tax district clerk that no action will be taken.
YES If "YES", continue.
NOWould the If "NO", notify tax district clerk that no action will be taken.
YES If "YES", we will:
equalizedvalue have been different?
EITHER
OR
Adjust the equalized value by $
and the equalized value by $
Allow the sharing of the omitted taxes to the taxing jurisdictions.
Explanation of Determination:
Certify results and issue instructions to the clerks of the tax district.
2018
X
X
X
Request for Sharing of Non-Manufacturing Omitted Property Taxes
Wisconsin Department of RevenuePC-205 (N. 10-10) R614
See reverse side of form for DOR determination and explanation.
1
2
3
4
5
6
8
(Section 74.315, Wis. Stats.) DOR USE ONLY
Real Estate Parcel No.
Name of Property Owner
Real Estate
Year Tax Omitted
CASE NO.Town County Co Mun Code
TID # (if applicable):
Village City of
Omitted Assessed Value
Class(a)
Land(b)
Improvement(c)
Total (a + b)
Totals
Omitted Value
Net Omitted Taxes to be Shared With Taxing Jurisdictions - EXCLUDING INTEREST
a.
b.
c.1
c.2
d.
e.
f.
g.
h.
Code Name of Taxing Jurisdictions Net Tax
State of Wisconsin
County
Captured explanation.
Municipality (Local)
Total Net Tax Rescinded or Refunded - EXCLUDING INTEREST
Personal Property Account No.
Year added to Tax Roll
Personal Property
7 Was the omitted tax offset by a related corresponding adjustment?a.If Yes,provide:
Was a chargeback form (PC-201) filed for this related parcel/account number?b.
Parcel/Account No. Tax Amount
Yes No
Yes No
19 0104
2018 2019X PLYMOUTH SHEBOYGAN 59 016
X 59016245478
ANDREW J AND JAMIE L SEMBER
1 29,900.00 126,200.00 156,100.00
29,900.00 126,200.00 156,100.00
.00 842.77
.00 .00
117.13 59 4473 SCH D OF PLYMOUTH 1,262.29 .00 00 1100 LAKESHORE TECHNICAL COLLEGE CLEV 121.07
2,343.26
X
X
The assessor placed the value for this parcel on a contiguous non-improved parcel (parcel number 59016245477 - rescinded case number 201900834). Basically, the values for these 2 parcels were reversed.
Wisconsin Department of RevenuePC-205 (N. 10-10) R614B
9
10
11
12
NO
- 2 -
Qualify for equalization test?
DEPARTMENT OF REVENUE DETERMINATION
If "NO", notify tax district clerk that no action will be taken.
YES If "YES", continue.
NOWould the If "NO", notify tax district clerk that no action will be taken.
YES If "YES", we will:
equalizedvalue have been different?
EITHER
OR
Adjust the equalized value by $
and the equalized value by $
Allow the sharing of the omitted taxes to the taxing jurisdictions.
Explanation of Determination:
Certify results and issue instructions to the clerks of the tax district.
2018
X
X
X
Request for Sharing of Non-Manufacturing Omitted Property Taxes
Wisconsin Department of RevenuePC-205 (N. 10-10) R614
See reverse side of form for DOR determination and explanation.
1
2
3
4
5
6
8
(Section 74.315, Wis. Stats.) DOR USE ONLY
Real Estate Parcel No.
Name of Property Owner
Real Estate
Year Tax Omitted
CASE NO.Town County Co Mun Code
TID # (if applicable):
Village City of
Omitted Assessed Value
Class(a)
Land(b)
Improvement(c)
Total (a + b)
Totals
Omitted Value
Net Omitted Taxes to be Shared With Taxing Jurisdictions - EXCLUDING INTEREST
a.
b.
c.1
c.2
d.
e.
f.
g.
h.
Code Name of Taxing Jurisdictions Net Tax
State of Wisconsin
County
Captured explanation.
Municipality (Local)
Total Net Tax Rescinded or Refunded - EXCLUDING INTEREST
Personal Property Account No.
Year added to Tax Roll
Personal Property
7 Was the omitted tax offset by a related corresponding adjustment?a.If Yes,provide:
Was a chargeback form (PC-201) filed for this related parcel/account number?b.
Parcel/Account No. Tax Amount
Yes No
Yes No
19 0106
2017 2019X SHEBOYGAN FALLS SHEBOYGAN 59 026
X 59026385863
STUART A BLANKE
1 24,600.00 221,120.00 245,720.00
24,600.00 221,120.00 245,720.00
.00 1,343.10
.00 .00
308.67 59 4473 SCH D OF PLYMOUTH 1,912.25 .00 00 1100 LAKESHORE TECHNICAL COLLEGE CLEV 193.40
3,757.42
X
X
Assessor did not include new construction on the 2017 assessment roll.
Wisconsin Department of RevenuePC-205 (N. 10-10) R614B
9
10
11
12
NO
- 2 -
Qualify for equalization test?
DEPARTMENT OF REVENUE DETERMINATION
If "NO", notify tax district clerk that no action will be taken.
YES If "YES", continue.
NOWould the If "NO", notify tax district clerk that no action will be taken.
YES If "YES", we will:
equalizedvalue have been different?
EITHER
OR
Adjust the equalized value by $
and the equalized value by $
Allow the sharing of the omitted taxes to the taxing jurisdictions.
Explanation of Determination:
Certify results and issue instructions to the clerks of the tax district.
2017
X
X
X
X
New construction was omitted from the assessment roll and
not included on the Municipal Assessment Report. Therefore
the Equalized Value was impacted.
Request for Sharing of Non-Manufacturing Omitted Property Taxes
Wisconsin Department of RevenuePC-205 (N. 10-10) R614
See reverse side of form for DOR determination and explanation.
1
2
3
4
5
6
8
(Section 74.315, Wis. Stats.) DOR USE ONLY
Real Estate Parcel No.
Name of Property Owner
Real Estate
Year Tax Omitted
CASE NO.Town County Co Mun Code
TID # (if applicable):
Village City of
Omitted Assessed Value
Class(a)
Land(b)
Improvement(c)
Total (a + b)
Totals
Omitted Value
Net Omitted Taxes to be Shared With Taxing Jurisdictions - EXCLUDING INTEREST
a.
b.
c.1
c.2
d.
e.
f.
g.
h.
Code Name of Taxing Jurisdictions Net Tax
State of Wisconsin
County
Captured explanation.
Municipality (Local)
Total Net Tax Rescinded or Refunded - EXCLUDING INTEREST
Personal Property Account No.
Year added to Tax Roll
Personal Property
7 Was the omitted tax offset by a related corresponding adjustment?a.If Yes,provide:
Was a chargeback form (PC-201) filed for this related parcel/account number?b.
Parcel/Account No. Tax Amount
Yes No
Yes No
19 0107
2018 2019X SHEBOYGAN FALLS SHEBOYGAN 59 026
X 59026385863
STUART A BLANKE
1 24,700.00 276,400.00 301,100.00
24,700.00 276,400.00 301,100.00
.00 1,614.93
.00 .00
408.05 59 4473 SCH D OF PLYMOUTH 2,422.63 .00 00 1100 LAKESHORE TECHNICAL COLLEGE CLEV 232.00
4,677.61
X
X
Assessor did not include new construction on the 2018 assessment roll.
Wisconsin Department of RevenuePC-205 (N. 10-10) R614B
9
10
11
12
NO
- 2 -
Qualify for equalization test?
DEPARTMENT OF REVENUE DETERMINATION
If "NO", notify tax district clerk that no action will be taken.
YES If "YES", continue.
NOWould the If "NO", notify tax district clerk that no action will be taken.
YES If "YES", we will:
equalizedvalue have been different?
EITHER
OR
Adjust the equalized value by $
and the equalized value by $
Allow the sharing of the omitted taxes to the taxing jurisdictions.
Explanation of Determination:
Certify results and issue instructions to the clerks of the tax district.
2018
X
X
X
X
New construction was omitted from the assessment roll
and not included on the Municipal Assessment Report.
Therefore the Equalized Value was impacted. PMG
Request for Sharing of Non-Manufacturing Omitted Property Taxes
Wisconsin Department of RevenuePC-205 (N. 10-10) R614
See reverse side of form for DOR determination and explanation.
1
2
3
4
5
6
8
(Section 74.315, Wis. Stats.) DOR USE ONLY
Real Estate Parcel No.
Name of Property Owner
Real Estate
Year Tax Omitted
CASE NO.Town County Co Mun Code
TID # (if applicable):
Village City of
Omitted Assessed Value
Class(a)
Land(b)
Improvement(c)
Total (a + b)
Totals
Omitted Value
Net Omitted Taxes to be Shared With Taxing Jurisdictions - EXCLUDING INTEREST
a.
b.
c.1
c.2
d.
e.
f.
g.
h.
Code Name of Taxing Jurisdictions Net Tax
State of Wisconsin
County
Captured explanation.
Municipality (Local)
Total Net Tax Rescinded or Refunded - EXCLUDING INTEREST
Personal Property Account No.
Year added to Tax Roll
Personal Property
7 Was the omitted tax offset by a related corresponding adjustment?a.If Yes,provide:
Was a chargeback form (PC-201) filed for this related parcel/account number?b.
Parcel/Account No. Tax Amount
Yes No
Yes No
19 0182
2018 2019X SHEBOYGAN FALLS SHEBOYGAN 59 026
X 59026382311
ANDREW H BOLL
1 47,000.00 135,000.00 182,000.00
47,000.00 135,000.00 182,000.00
.00 976.15
.00 .00
246.65 59 4473 SCH D OF PLYMOUTH 1,464.36 .00 00 1100 LAKESHORE TECHNICAL COLLEGE CLEV 140.23
2,827.39
X
X
Assessor did not include new construction on the 2018 assessment roll.
Wisconsin Department of RevenuePC-205 (N. 10-10) R614B
9
10
11
12
NO
- 2 -
Qualify for equalization test?
DEPARTMENT OF REVENUE DETERMINATION
If "NO", notify tax district clerk that no action will be taken.
YES If "YES", continue.
NOWould the If "NO", notify tax district clerk that no action will be taken.
YES If "YES", we will:
equalizedvalue have been different?
EITHER
OR
Adjust the equalized value by $
and the equalized value by $
Allow the sharing of the omitted taxes to the taxing jurisdictions.
Explanation of Determination:
Certify results and issue instructions to the clerks of the tax district.
2018
X
X
X
X
New construction was omitted from the assessment roll and
not included on the Municipal Assessment Report. Therefore
the Equalized Value was impacted - PMG
Request for Sharing of Non-Manufacturing Omitted Property Taxes
Wisconsin Department of RevenuePC-205 (N. 10-10) R614
See reverse side of form for DOR determination and explanation.
1
2
3
4
5
6
8
(Section 74.315, Wis. Stats.) DOR USE ONLY
Real Estate Parcel No.
Name of Property Owner
Real Estate
Year Tax Omitted
CASE NO.Town County Co Mun Code
TID # (if applicable):
Village City of
Omitted Assessed Value
Class(a)
Land(b)
Improvement(c)
Total (a + b)
Totals
Omitted Value
Net Omitted Taxes to be Shared With Taxing Jurisdictions - EXCLUDING INTEREST
a.
b.
c.1
c.2
d.
e.
f.
g.
h.
Code Name of Taxing Jurisdictions Net Tax
State of Wisconsin
County
Captured explanation.
Municipality (Local)
Total Net Tax Rescinded or Refunded - EXCLUDING INTEREST
Personal Property Account No.
Year added to Tax Roll
Personal Property
7 Was the omitted tax offset by a related corresponding adjustment?a.If Yes,provide:
Was a chargeback form (PC-201) filed for this related parcel/account number?b.
Parcel/Account No. Tax Amount
Yes No
Yes No
19 0183
2018 2019X SHEBOYGAN FALLS SHEBOYGAN 59 026
X 59026383040
RONALD J BURROWS SR
1 23,300.00 57,550.00 80,850.00
23,300.00 57,550.00 80,850.00
.00 437.24
.00 .00
110.48 59 5278 SCH D OF SHEBOYGAN FALLS 755.08 .00 00 1100 LAKESHORE TECHNICAL COLLEGE CLEV 62.81
1,365.61
X
X
Assessor did not include new construction on the 2018 assessment roll.
Wisconsin Department of RevenuePC-205 (N. 10-10) R614B
9
10
11
12
NO
- 2 -
Qualify for equalization test?
DEPARTMENT OF REVENUE DETERMINATION
If "NO", notify tax district clerk that no action will be taken.
YES If "YES", continue.
NOWould the If "NO", notify tax district clerk that no action will be taken.
YES If "YES", we will:
equalizedvalue have been different?
EITHER
OR
Adjust the equalized value by $
and the equalized value by $
Allow the sharing of the omitted taxes to the taxing jurisdictions.
Explanation of Determination:
Certify results and issue instructions to the clerks of the tax district.
2018
X
X
X
X
New construction was omitted from the assessment roll and
not included on the Municipal Assessment Report. Therefore
the Equalized Value was impacted. PMG
Request for Sharing of Non-Manufacturing Omitted Property Taxes
Wisconsin Department of RevenuePC-205 (N. 10-10) R614
See reverse side of form for DOR determination and explanation.
1
2
3
4
5
6
8
(Section 74.315, Wis. Stats.) DOR USE ONLY
Real Estate Parcel No.
Name of Property Owner
Real Estate
Year Tax Omitted
CASE NO.Town County Co Mun Code
TID # (if applicable):
Village City of
Omitted Assessed Value
Class(a)
Land(b)
Improvement(c)
Total (a + b)
Totals
Omitted Value
Net Omitted Taxes to be Shared With Taxing Jurisdictions - EXCLUDING INTEREST
a.
b.
c.1
c.2
d.
e.
f.
g.
h.
Code Name of Taxing Jurisdictions Net Tax
State of Wisconsin
County
Captured explanation.
Municipality (Local)
Total Net Tax Rescinded or Refunded - EXCLUDING INTEREST
Personal Property Account No.
Year added to Tax Roll
Personal Property
7 Was the omitted tax offset by a related corresponding adjustment?a.If Yes,provide:
Was a chargeback form (PC-201) filed for this related parcel/account number?b.
Parcel/Account No. Tax Amount
Yes No
Yes No
19 0184
2018 2019X SHEBOYGAN FALLS SHEBOYGAN 59 026
X 59026385978
SCHOLLER PROPERTY MANAGEMENT LLC
2 26,100.00 264,700.00 290,800.00
26,100.00 264,700.00 290,800.00
.00 1,572.67
.00 .00
397.37 59 5278 SCH D OF SHEBOYGAN FALLS 2,715.86 .00 00 1100 LAKESHORE TECHNICAL COLLEGE CLEV 225.93
4,911.83
X
X
Assessor did not include new construction on the 2018 assessment roll.
Wisconsin Department of RevenuePC-205 (N. 10-10) R614B
9
10
11
12
NO
- 2 -
Qualify for equalization test?
DEPARTMENT OF REVENUE DETERMINATION
If "NO", notify tax district clerk that no action will be taken.
YES If "YES", continue.
NOWould the If "NO", notify tax district clerk that no action will be taken.
YES If "YES", we will:
equalizedvalue have been different?
EITHER
OR
Adjust the equalized value by $
and the equalized value by $
Allow the sharing of the omitted taxes to the taxing jurisdictions.
Explanation of Determination:
Certify results and issue instructions to the clerks of the tax district.
2018
X
X
X
X
New construction was omitted from the assessment roll and
not included on the Municipal Assessment Report. Therefore
the Equalized Value was impacted. - PMG
Request for Sharing of Non-Manufacturing Omitted Property Taxes
Wisconsin Department of RevenuePC-205 (N. 10-10) R614
See reverse side of form for DOR determination and explanation.
1
2
3
4
5
6
8
(Section 74.315, Wis. Stats.) DOR USE ONLY
Real Estate Parcel No.
Name of Property Owner
Real Estate
Year Tax Omitted
CASE NO.Town County Co Mun Code
TID # (if applicable):
Village City of
Omitted Assessed Value
Class(a)
Land(b)
Improvement(c)
Total (a + b)
Totals
Omitted Value
Net Omitted Taxes to be Shared With Taxing Jurisdictions - EXCLUDING INTEREST
a.
b.
c.1
c.2
d.
e.
f.
g.
h.
Code Name of Taxing Jurisdictions Net Tax
State of Wisconsin
County
Captured explanation.
Municipality (Local)
Total Net Tax Rescinded or Refunded - EXCLUDING INTEREST
Personal Property Account No.
Year added to Tax Roll
Personal Property
7 Was the omitted tax offset by a related corresponding adjustment?a.If Yes,provide:
Was a chargeback form (PC-201) filed for this related parcel/account number?b.
Parcel/Account No. Tax Amount
Yes No
Yes No
19 0185
2018 2019X SHEBOYGAN FALLS SHEBOYGAN 59 026
X 59026392886
ERIC J AND JESSICA L LAUERSDORF
1 22,100.00 325,900.00 348,000.00
22,100.00 325,900.00 348,000.00
.00 1,882.88
59 7140 SHEBOYGAN SANITARY DISTRICT #2 26.00 .00
475.76 59 5278 SCH D OF SHEBOYGAN FALLS 3,251.58 .00 00 1100 LAKESHORE TECHNICAL COLLEGE CLEV 270.49
5,906.71
X
X
Assessor did not include new construction on the 2018 assessment roll.
Wisconsin Department of RevenuePC-205 (N. 10-10) R614B
9
10
11
12
NO
- 2 -
Qualify for equalization test?
DEPARTMENT OF REVENUE DETERMINATION
If "NO", notify tax district clerk that no action will be taken.
YES If "YES", continue.
NOWould the If "NO", notify tax district clerk that no action will be taken.
YES If "YES", we will:
equalizedvalue have been different?
EITHER
OR
Adjust the equalized value by $
and the equalized value by $
Allow the sharing of the omitted taxes to the taxing jurisdictions.
Explanation of Determination:
Certify results and issue instructions to the clerks of the tax district.
2018
X
X
X
X
New construction was omitted from the assessment roll and
not included on the Municipal Assessment Report. Therefore
the Equalized Value was impacted. - PMG
Request for Sharing of Non-Manufacturing Omitted Property Taxes
Wisconsin Department of RevenuePC-205 (N. 10-10) R614
See reverse side of form for DOR determination and explanation.
1
2
3
4
5
6
8
(Section 74.315, Wis. Stats.) DOR USE ONLY
Real Estate Parcel No.
Name of Property Owner
Real Estate
Year Tax Omitted
CASE NO.Town County Co Mun Code
TID # (if applicable):
Village City of
Omitted Assessed Value
Class(a)
Land(b)
Improvement(c)
Total (a + b)
Totals
Omitted Value
Net Omitted Taxes to be Shared With Taxing Jurisdictions - EXCLUDING INTEREST
a.
b.
c.1
c.2
d.
e.
f.
g.
h.
Code Name of Taxing Jurisdictions Net Tax
State of Wisconsin
County
Captured explanation.
Municipality (Local)
Total Net Tax Rescinded or Refunded - EXCLUDING INTEREST
Personal Property Account No.
Year added to Tax Roll
Personal Property
7 Was the omitted tax offset by a related corresponding adjustment?a.If Yes,provide:
Was a chargeback form (PC-201) filed for this related parcel/account number?b.
Parcel/Account No. Tax Amount
Yes No
Yes No
19 0110
2017 2019X SHERMAN SHEBOYGAN 59 028
X 59028427720
LORENZ TRUST
1 .00 443,000.00 443,000.00
.00 443,000.00 443,000.00
.00 2,095.83
.00 .00
1,016.02 59 4641 SCH D OF RANDOM LAKE 3,373.85 .00 00 1100 LAKESHORE TECHNICAL COLLEGE CLEV 321.06
6,806.76
X
X
Assessor did not include new construction on the 2017 assessment roll.
Wisconsin Department of RevenuePC-205 (N. 10-10) R614B
9
10
11
12
NO
- 2 -
Qualify for equalization test?
DEPARTMENT OF REVENUE DETERMINATION
If "NO", notify tax district clerk that no action will be taken.
YES If "YES", continue.
NOWould the If "NO", notify tax district clerk that no action will be taken.
YES If "YES", we will:
equalizedvalue have been different?
EITHER
OR
Adjust the equalized value by $
and the equalized value by $
Allow the sharing of the omitted taxes to the taxing jurisdictions.
Explanation of Determination:
Certify results and issue instructions to the clerks of the tax district.
2017
X
X
X
X
New construction was omitted from the assessment roll and
not included on the Municipal Assessment Report. Therefore
the Equalized Value was impacted. PMG
Request for Sharing of Non-Manufacturing Omitted Property Taxes
Wisconsin Department of RevenuePC-205 (N. 10-10) R614
See reverse side of form for DOR determination and explanation.
1
2
3
4
5
6
8
(Section 74.315, Wis. Stats.) DOR USE ONLY
Real Estate Parcel No.
Name of Property Owner
Real Estate
Year Tax Omitted
CASE NO.Town County Co Mun Code
TID # (if applicable):
Village City of
Omitted Assessed Value
Class(a)
Land(b)
Improvement(c)
Total (a + b)
Totals
Omitted Value
Net Omitted Taxes to be Shared With Taxing Jurisdictions - EXCLUDING INTEREST
a.
b.
c.1
c.2
d.
e.
f.
g.
h.
Code Name of Taxing Jurisdictions Net Tax
State of Wisconsin
County
Captured explanation.
Municipality (Local)
Total Net Tax Rescinded or Refunded - EXCLUDING INTEREST
Personal Property Account No.
Year added to Tax Roll
Personal Property
7 Was the omitted tax offset by a related corresponding adjustment?a.If Yes,provide:
Was a chargeback form (PC-201) filed for this related parcel/account number?b.
Parcel/Account No. Tax Amount
Yes No
Yes No
19 0111
2018 2019X SHERMAN SHEBOYGAN 59 028
X 59028427720
LORENZ TRUST
1 .00 443,000.00 443,000.00
.00 443,000.00 443,000.00
.00 2,070.54
.00 .00
1,053.16 59 4641 SCH D OF RANDOM LAKE 3,608.96 .00 00 1100 LAKESHORE TECHNICAL COLLEGE CLEV 318.09
7,050.75
X
X
Assessor did not include new construction on the 2018 assessment roll.
Wisconsin Department of RevenuePC-205 (N. 10-10) R614B
9
10
11
12
NO
- 2 -
Qualify for equalization test?
DEPARTMENT OF REVENUE DETERMINATION
If "NO", notify tax district clerk that no action will be taken.
YES If "YES", continue.
NOWould the If "NO", notify tax district clerk that no action will be taken.
YES If "YES", we will:
equalizedvalue have been different?
EITHER
OR
Adjust the equalized value by $
and the equalized value by $
Allow the sharing of the omitted taxes to the taxing jurisdictions.
Explanation of Determination:
Certify results and issue instructions to the clerks of the tax district.
2018
X
X
X
X
New construction was omitted from the assessment roll and
not included on the Municipal Assessment Report. Therefore
the Equalized Value was impacted. - PMG
Request for Sharing of Non-Manufacturing Omitted Property Taxes
Wisconsin Department of RevenuePC-205 (N. 10-10) R614
See reverse side of form for DOR determination and explanation.
1
2
3
4
5
6
8
(Section 74.315, Wis. Stats.) DOR USE ONLY
Real Estate Parcel No.
Name of Property Owner
Real Estate
Year Tax Omitted
CASE NO.Town County Co Mun Code
TID # (if applicable):
Village City of
Omitted Assessed Value
Class(a)
Land(b)
Improvement(c)
Total (a + b)
Totals
Omitted Value
Net Omitted Taxes to be Shared With Taxing Jurisdictions - EXCLUDING INTEREST
a.
b.
c.1
c.2
d.
e.
f.
g.
h.
Code Name of Taxing Jurisdictions Net Tax
State of Wisconsin
County
Captured explanation.
Municipality (Local)
Total Net Tax Rescinded or Refunded - EXCLUDING INTEREST
Personal Property Account No.
Year added to Tax Roll
Personal Property
7 Was the omitted tax offset by a related corresponding adjustment?a.If Yes,provide:
Was a chargeback form (PC-201) filed for this related parcel/account number?b.
Parcel/Account No. Tax Amount
Yes No
Yes No
19 0112
2018 2019 XPLYMOUTH SHEBOYGAN 59 271
X 59271829646 005
PAMELA A TURICIK
1 .00 208,400.00 208,400.00
.00 208,400.00 208,400.00
.00 878.18
.00 .00
1,809.10 59 4473 SCH D OF PLYMOUTH 1,424.89 .00 00 1100 LAKESHORE TECHNICAL COLLEGE CLEV 136.67
4,248.84
X
X
Assessor did not include the new construction on the 2018 assessment roll.
Wisconsin Department of RevenuePC-205 (N. 10-10) R614B
9
10
11
12
NO
- 2 -
Qualify for equalization test?
DEPARTMENT OF REVENUE DETERMINATION
If "NO", notify tax district clerk that no action will be taken.
YES If "YES", continue.
NOWould the If "NO", notify tax district clerk that no action will be taken.
YES If "YES", we will:
equalizedvalue have been different?
EITHER
OR
Adjust the equalized value by $
and the equalized value by $
Allow the sharing of the omitted taxes to the taxing jurisdictions.
Explanation of Determination:
Certify results and issue instructions to the clerks of the tax district.
2018
X
X
X
The omitted assessment is located on property in a TID. The
error exists in both the Equalized Value and the TID value.
In this TID the error does not affect tax apportionment. The
refore omitted taxes collected do not need to be shared. PMG
Request for Sharing of Non-Manufacturing Omitted Property Taxes
Wisconsin Department of RevenuePC-205 (N. 10-10) R614
See reverse side of form for DOR determination and explanation.
1
2
3
4
5
6
8
(Section 74.315, Wis. Stats.) DOR USE ONLY
Real Estate Parcel No.
Name of Property Owner
Real Estate
Year Tax Omitted
CASE NO.Town County Co Mun Code
TID # (if applicable):
Village City of
Omitted Assessed Value
Class(a)
Land(b)
Improvement(c)
Total (a + b)
Totals
Omitted Value
Net Omitted Taxes to be Shared With Taxing Jurisdictions - EXCLUDING INTEREST
a.
b.
c.1
c.2
d.
e.
f.
g.
h.
Code Name of Taxing Jurisdictions Net Tax
State of Wisconsin
County
Captured explanation.
Municipality (Local)
Total Net Tax Rescinded or Refunded - EXCLUDING INTEREST
Personal Property Account No.
Year added to Tax Roll
Personal Property
7 Was the omitted tax offset by a related corresponding adjustment?a.If Yes,provide:
Was a chargeback form (PC-201) filed for this related parcel/account number?b.
Parcel/Account No. Tax Amount
Yes No
Yes No
19 0113
2018 2019 XPLYMOUTH SHEBOYGAN 59 271
X 59271829647 005
DALE L AND MARY A STOLTZMAN
1 .00 198,600.00 198,600.00
.00 198,600.00 198,600.00
.00 836.89
.00 .00
1,724.03 59 4473 SCH D OF PLYMOUTH 1,357.88 .00 00 1100 LAKESHORE TECHNICAL COLLEGE CLEV 130.24
4,049.04
X
X
Assessor did not include the new construction on the 2018 assessment roll.
Wisconsin Department of RevenuePC-205 (N. 10-10) R614B
9
10
11
12
NO
- 2 -
Qualify for equalization test?
DEPARTMENT OF REVENUE DETERMINATION
If "NO", notify tax district clerk that no action will be taken.
YES If "YES", continue.
NOWould the If "NO", notify tax district clerk that no action will be taken.
YES If "YES", we will:
equalizedvalue have been different?
EITHER
OR
Adjust the equalized value by $
and the equalized value by $
Allow the sharing of the omitted taxes to the taxing jurisdictions.
Explanation of Determination:
Certify results and issue instructions to the clerks of the tax district.
2018
X
X
X
Omitted assessment is located on property in a TID. The
error exists in both the Equalized Value and the TID Value.
In this TID the error does not affect tax apportionment.
Therefore the omitted taxes do not need to be shared. PMG
Request for Sharing of Non-Manufacturing Omitted Property Taxes
Wisconsin Department of RevenuePC-205 (N. 10-10) R614
See reverse side of form for DOR determination and explanation.
1
2
3
4
5
6
8
(Section 74.315, Wis. Stats.) DOR USE ONLY
Real Estate Parcel No.
Name of Property Owner
Real Estate
Year Tax Omitted
CASE NO.Town County Co Mun Code
TID # (if applicable):
Village City of
Omitted Assessed Value
Class(a)
Land(b)
Improvement(c)
Total (a + b)
Totals
Omitted Value
Net Omitted Taxes to be Shared With Taxing Jurisdictions - EXCLUDING INTEREST
a.
b.
c.1
c.2
d.
e.
f.
g.
h.
Code Name of Taxing Jurisdictions Net Tax
State of Wisconsin
County
Captured explanation.
Municipality (Local)
Total Net Tax Rescinded or Refunded - EXCLUDING INTEREST
Personal Property Account No.
Year added to Tax Roll
Personal Property
7 Was the omitted tax offset by a related corresponding adjustment?a.If Yes,provide:
Was a chargeback form (PC-201) filed for this related parcel/account number?b.
Parcel/Account No. Tax Amount
Yes No
Yes No
19 0035
2018 2019 X EAST TROY WALWORTH 64 121
X RLB 00144, RLB 00141
SATTLER AND BIELINSKI
1 .00 223,500.00 223,500.00 7 .00 235,000.00 235,000.00
.00 458,500.00 458,500.00
.00 1,640.44
.00 .00
3,832.29 64 1540 SCH D OF EAST TROY COMMUNITY 3,862.75 .00 00 0600 GATEWAY TECHNICAL COLLEGE KENO 337.18
9,672.66
X
X
In late May our assessor informed us there was an omission of assessed value for the improvements on the properties. The property tax bills issued in December of 2018 only included the assessment of land. The homes were complete but the assessed value for the homes were missed.Both of these properties are residential, however i was not to list them both as such on this form
Wisconsin Department of RevenuePC-205 (N. 10-10) R614B
9
10
11
12
NO
- 2 -
Qualify for equalization test?
DEPARTMENT OF REVENUE DETERMINATION
If "NO", notify tax district clerk that no action will be taken.
YES If "YES", continue.
NOWould the If "NO", notify tax district clerk that no action will be taken.
YES If "YES", we will:
equalizedvalue have been different?
EITHER
OR
Adjust the equalized value by $
and the equalized value by $
Allow the sharing of the omitted taxes to the taxing jurisdictions.
Explanation of Determination:
Certify results and issue instructions to the clerks of the tax district.
2018
X
X
X
X
Existing real property was omitted for the current year and
previous year.Property omitted in the previous year's assess
ment totals impacts the current year's economic adjustments.
Therefore the equalized value was affected.
Request for Sharing of Non-Manufacturing Omitted Property Taxes
Wisconsin Department of RevenuePC-205 (N. 10-10) R614
See reverse side of form for DOR determination and explanation.
1
2
3
4
5
6
8
(Section 74.315, Wis. Stats.) DOR USE ONLY
Real Estate Parcel No.
Name of Property Owner
Real Estate
Year Tax Omitted
CASE NO.Town County Co Mun Code
TID # (if applicable):
Village City of
Omitted Assessed Value
Class(a)
Land(b)
Improvement(c)
Total (a + b)
Totals
Omitted Value
Net Omitted Taxes to be Shared With Taxing Jurisdictions - EXCLUDING INTEREST
a.
b.
c.1
c.2
d.
e.
f.
g.
h.
Code Name of Taxing Jurisdictions Net Tax
State of Wisconsin
County
Captured explanation.
Municipality (Local)
Total Net Tax Rescinded or Refunded - EXCLUDING INTEREST
Personal Property Account No.
Year added to Tax Roll
Personal Property
7 Was the omitted tax offset by a related corresponding adjustment?a.If Yes,provide:
Was a chargeback form (PC-201) filed for this related parcel/account number?b.
Parcel/Account No. Tax Amount
Yes No
Yes No
19 0020
2018 2019 X GERMANTOWN WASHINGTON 66 131
XPA334-001-98
AURORA MEDICAL GROUP INC
.00 .00 .00
1,782,700.00
.00 4,014.12
.00 .00
9,328.55 66 2058 SCH D OF GERMANTOWN 15,621.91 .00 00 0900 MILWAUKEE AREA TECHNICAL COLLEGE MILW 2,055.83
31,020.41
X
X
Property owner contacted Associated Appraisal and informed them that they had not received a personal property bill, Associated did a valuation of the personal property, contacted the Village of Germantown. A tax bill was created and sent to Aurora January 4, 2019.
Wisconsin Department of RevenuePC-205 (N. 10-10) R614B
9
10
11
12
NO
- 2 -
Qualify for equalization test?
DEPARTMENT OF REVENUE DETERMINATION
If "NO", notify tax district clerk that no action will be taken.
YES If "YES", continue.
NOWould the If "NO", notify tax district clerk that no action will be taken.
YES If "YES", we will:
equalizedvalue have been different?
EITHER
OR
Adjust the equalized value by $
and the equalized value by $
Allow the sharing of the omitted taxes to the taxing jurisdictions.
Explanation of Determination:
Certify results and issue instructions to the clerks of the tax district.
2018
X
X
X
X
Personal property was omitted from the assessment roll and
not included on the Municipal Assessment Report.
The Equalized Value is impacted.
Request for Sharing of Non-Manufacturing Omitted Property Taxes
Wisconsin Department of RevenuePC-205 (N. 10-10) R614
See reverse side of form for DOR determination and explanation.
1
2
3
4
5
6
8
(Section 74.315, Wis. Stats.) DOR USE ONLY
Real Estate Parcel No.
Name of Property Owner
Real Estate
Year Tax Omitted
CASE NO.Town County Co Mun Code
TID # (if applicable):
Village City of
Omitted Assessed Value
Class(a)
Land(b)
Improvement(c)
Total (a + b)
Totals
Omitted Value
Net Omitted Taxes to be Shared With Taxing Jurisdictions - EXCLUDING INTEREST
a.
b.
c.1
c.2
d.
e.
f.
g.
h.
Code Name of Taxing Jurisdictions Net Tax
State of Wisconsin
County
Captured explanation.
Municipality (Local)
Total Net Tax Rescinded or Refunded - EXCLUDING INTEREST
Personal Property Account No.
Year added to Tax Roll
Personal Property
7 Was the omitted tax offset by a related corresponding adjustment?a.If Yes,provide:
Was a chargeback form (PC-201) filed for this related parcel/account number?b.
Parcel/Account No. Tax Amount
Yes No
Yes No
19 0187
2017 2019 XHARTFORD WASHINGTON 66 236
X 36-2402-001-031
POWDER HILL TERRACE LLC
1 .00 920,200.00 920,200.00
.00 920,200.00 920,200.00
.00 2,156.50
.00 .00
5,301.30 66 5390 SCH D OF SLINGER 7,317.29 .00 00 1000 MORAINE PARK TECHNICAL COLLEGE FDLC 562.31
15,337.40
X
X
Improvements were omitted from assessment roll.
Wisconsin Department of RevenuePC-205 (N. 10-10) R614B
9
10
11
12
NO
- 2 -
Qualify for equalization test?
DEPARTMENT OF REVENUE DETERMINATION
If "NO", notify tax district clerk that no action will be taken.
YES If "YES", continue.
NOWould the If "NO", notify tax district clerk that no action will be taken.
YES If "YES", we will:
equalizedvalue have been different?
EITHER
OR
Adjust the equalized value by $
and the equalized value by $
Allow the sharing of the omitted taxes to the taxing jurisdictions.
Explanation of Determination:
Certify results and issue instructions to the clerks of the tax district.
2017
X
X
X
X
New Construction was omitted from the assessment roll and
not included on the Municipal Assessment Report. Therefore
The Equalized Value was impacted.
Request for Sharing of Non-Manufacturing Omitted Property Taxes
Wisconsin Department of RevenuePC-205 (N. 10-10) R614
See reverse side of form for DOR determination and explanation.
1
2
3
4
5
6
8
(Section 74.315, Wis. Stats.) DOR USE ONLY
Real Estate Parcel No.
Name of Property Owner
Real Estate
Year Tax Omitted
CASE NO.Town County Co Mun Code
TID # (if applicable):
Village City of
Omitted Assessed Value
Class(a)
Land(b)
Improvement(c)
Total (a + b)
Totals
Omitted Value
Net Omitted Taxes to be Shared With Taxing Jurisdictions - EXCLUDING INTEREST
a.
b.
c.1
c.2
d.
e.
f.
g.
h.
Code Name of Taxing Jurisdictions Net Tax
State of Wisconsin
County
Captured explanation.
Municipality (Local)
Total Net Tax Rescinded or Refunded - EXCLUDING INTEREST
Personal Property Account No.
Year added to Tax Roll
Personal Property
7 Was the omitted tax offset by a related corresponding adjustment?a.If Yes,provide:
Was a chargeback form (PC-201) filed for this related parcel/account number?b.
Parcel/Account No. Tax Amount
Yes No
Yes No
19 0189
2018 2019 XHARTFORD WASHINGTON 66 236
X 36-2402-001-031
POWDER HILL TERRACE LLC
1 .00 1,093,800.00 1,093,800.00
.00 1,093,800.00 1,093,800.00
.00 2,454.53
.00 .00
6,014.78 66 5390 SCH D OF SLINGER 8,256.88 .00 00 1000 MORAINE PARK TECHNICAL COLLEGE FDLC 652.05
17,378.24
X
X
Improvements were omitted from assessment roll
Wisconsin Department of RevenuePC-205 (N. 10-10) R614B
9
10
11
12
NO
- 2 -
Qualify for equalization test?
DEPARTMENT OF REVENUE DETERMINATION
If "NO", notify tax district clerk that no action will be taken.
YES If "YES", continue.
NOWould the If "NO", notify tax district clerk that no action will be taken.
YES If "YES", we will:
equalizedvalue have been different?
EITHER
OR
Adjust the equalized value by $
and the equalized value by $
Allow the sharing of the omitted taxes to the taxing jurisdictions.
Explanation of Determination:
Certify results and issue instructions to the clerks of the tax district.
2018
X
X
X
X
New construction was omitted from the assessment roll and
not included on the Municipal Assessment Report. Therefore
the Equalized Value was impacted.
Request for Sharing of Non-Manufacturing Omitted Property Taxes
Wisconsin Department of RevenuePC-205 (N. 10-10) R614
See reverse side of form for DOR determination and explanation.
1
2
3
4
5
6
8
(Section 74.315, Wis. Stats.) DOR USE ONLY
Real Estate Parcel No.
Name of Property Owner
Real Estate
Year Tax Omitted
CASE NO.Town County Co Mun Code
TID # (if applicable):
Village City of
Omitted Assessed Value
Class(a)
Land(b)
Improvement(c)
Total (a + b)
Totals
Omitted Value
Net Omitted Taxes to be Shared With Taxing Jurisdictions - EXCLUDING INTEREST
a.
b.
c.1
c.2
d.
e.
f.
g.
h.
Code Name of Taxing Jurisdictions Net Tax
State of Wisconsin
County
Captured explanation.
Municipality (Local)
Total Net Tax Rescinded or Refunded - EXCLUDING INTEREST
Personal Property Account No.
Year added to Tax Roll
Personal Property
7 Was the omitted tax offset by a related corresponding adjustment?a.If Yes,provide:
Was a chargeback form (PC-201) filed for this related parcel/account number?b.
Parcel/Account No. Tax Amount
Yes No
Yes No
19 0171
2018 2019 X MENOMONEE FALLS WAUKESHA 67 151
XMNFV M665 008
MR BREWS TAPHOUSE
.00 .00 .00
18,700.00
.00 30.86
.00 .00
108.91 67 3437 SCH D OF MENOMONEE FALLS 169.40 .00 00 0800 WAUKESHA COUNTY AREA TECH COLLEGE PEWA 5.91
315.08
X
X
Business did not file the PA-003 Statement of Personal Property form. Assessor missed picking it up.
Wisconsin Department of RevenuePC-205 (N. 10-10) R614B
9
10
11
12
NO
- 2 -
Qualify for equalization test?
DEPARTMENT OF REVENUE DETERMINATION
If "NO", notify tax district clerk that no action will be taken.
YES If "YES", continue.
NOWould the If "NO", notify tax district clerk that no action will be taken.
YES If "YES", we will:
equalizedvalue have been different?
EITHER
OR
Adjust the equalized value by $
and the equalized value by $
Allow the sharing of the omitted taxes to the taxing jurisdictions.
Explanation of Determination:
Certify results and issue instructions to the clerks of the tax district.
2018
X
X
X
The omitted assessment is located on property in a TID. The
error exists in both the Equalized Value and the TID Value.
In this TID the error does not affect the apportionment of
taxe. The taxes collected do not need to be shared.
Request for Sharing of Non-Manufacturing Omitted Property Taxes
Wisconsin Department of RevenuePC-205 (N. 10-10) R614
See reverse side of form for DOR determination and explanation.
1
2
3
4
5
6
8
(Section 74.315, Wis. Stats.) DOR USE ONLY
Real Estate Parcel No.
Name of Property Owner
Real Estate
Year Tax Omitted
CASE NO.Town County Co Mun Code
TID # (if applicable):
Village City of
Omitted Assessed Value
Class(a)
Land(b)
Improvement(c)
Total (a + b)
Totals
Omitted Value
Net Omitted Taxes to be Shared With Taxing Jurisdictions - EXCLUDING INTEREST
a.
b.
c.1
c.2
d.
e.
f.
g.
h.
Code Name of Taxing Jurisdictions Net Tax
State of Wisconsin
County
Captured explanation.
Municipality (Local)
Total Net Tax Rescinded or Refunded - EXCLUDING INTEREST
Personal Property Account No.
Year added to Tax Roll
Personal Property
7 Was the omitted tax offset by a related corresponding adjustment?a.If Yes,provide:
Was a chargeback form (PC-201) filed for this related parcel/account number?b.
Parcel/Account No. Tax Amount
Yes No
Yes No
19 0180
2018 2019 X MENOMONEE FALLS WAUKESHA 67 151
XMNFV B381
BROOK FURNITURE RENTAL INC
.00 .00 .00
22,450.00
.00 36.60
.00 .00
107.64 67 2420 SCH D OF HAMILTON (LISBON) 186.63 .00 00 0800 WAUKESHA COUNTY AREA TECH COLLEGE PEWA 7.01
337.88
X
X
Leasing company was marked inactive. The assessor received a completed PA-003 Statement of Personal Property form after the fact.
Wisconsin Department of RevenuePC-205 (N. 10-10) R614B
9
10
11
12
NO
- 2 -
Qualify for equalization test?
DEPARTMENT OF REVENUE DETERMINATION
If "NO", notify tax district clerk that no action will be taken.
YES If "YES", continue.
NOWould the If "NO", notify tax district clerk that no action will be taken.
YES If "YES", we will:
equalizedvalue have been different?
EITHER
OR
Adjust the equalized value by $
and the equalized value by $
Allow the sharing of the omitted taxes to the taxing jurisdictions.
Explanation of Determination:
Certify results and issue instructions to the clerks of the tax district.
2018
X
X
X
X
Personal property was omitted from the assessment roll and
not included on the Municipal Assessment Report.
The Equalized Value was impacted.
Request for Sharing of Non-Manufacturing Omitted Property Taxes
Wisconsin Department of RevenuePC-205 (N. 10-10) R614
See reverse side of form for DOR determination and explanation.
1
2
3
4
5
6
8
(Section 74.315, Wis. Stats.) DOR USE ONLY
Real Estate Parcel No.
Name of Property Owner
Real Estate
Year Tax Omitted
CASE NO.Town County Co Mun Code
TID # (if applicable):
Village City of
Omitted Assessed Value
Class(a)
Land(b)
Improvement(c)
Total (a + b)
Totals
Omitted Value
Net Omitted Taxes to be Shared With Taxing Jurisdictions - EXCLUDING INTEREST
a.
b.
c.1
c.2
d.
e.
f.
g.
h.
Code Name of Taxing Jurisdictions Net Tax
State of Wisconsin
County
Captured explanation.
Municipality (Local)
Total Net Tax Rescinded or Refunded - EXCLUDING INTEREST
Personal Property Account No.
Year added to Tax Roll
Personal Property
7 Was the omitted tax offset by a related corresponding adjustment?a.If Yes,provide:
Was a chargeback form (PC-201) filed for this related parcel/account number?b.
Parcel/Account No. Tax Amount
Yes No
Yes No
19 0186
2018 2019 X MENOMONEE FALLS WAUKESHA 67 151
XMNFV T333 008
TJX COMPANIES 1078
.00 .00 .00
326,000.00
.00 538.06
.00 .00
1,898.70 67 3437 SCH D OF MENOMONEE FALLS 2,953.25 .00 00 0800 WAUKESHA COUNTY AREA TECH COLLEGE PEWA 103.07
5,493.08
X
X
COMPANY SENT THE PA-003 STATEMENT OF PERSONAL PROPERTY FORM TO GERMANTOWN (THEIR PREVIOUS LOCATION). ASSESSOR MISSED PICKING IT UP.
Wisconsin Department of RevenuePC-205 (N. 10-10) R614B
9
10
11
12
NO
- 2 -
Qualify for equalization test?
DEPARTMENT OF REVENUE DETERMINATION
If "NO", notify tax district clerk that no action will be taken.
YES If "YES", continue.
NOWould the If "NO", notify tax district clerk that no action will be taken.
YES If "YES", we will:
equalizedvalue have been different?
EITHER
OR
Adjust the equalized value by $
and the equalized value by $
Allow the sharing of the omitted taxes to the taxing jurisdictions.
Explanation of Determination:
Certify results and issue instructions to the clerks of the tax district.
2018
X
X
X
The omitted assessment is on property located in a TID.The
error exists in both the Equalized Value and the TID Value.
In this TID the error does not affect the apportionment of
taxes. The taxes collected do not need to be shared.
Request for Sharing of Non-Manufacturing Omitted Property Taxes
Wisconsin Department of RevenuePC-205 (N. 10-10) R614
See reverse side of form for DOR determination and explanation.
1
2
3
4
5
6
8
(Section 74.315, Wis. Stats.) DOR USE ONLY
Real Estate Parcel No.
Name of Property Owner
Real Estate
Year Tax Omitted
CASE NO.Town County Co Mun Code
TID # (if applicable):
Village City of
Omitted Assessed Value
Class(a)
Land(b)
Improvement(c)
Total (a + b)
Totals
Omitted Value
Net Omitted Taxes to be Shared With Taxing Jurisdictions - EXCLUDING INTEREST
a.
b.
c.1
c.2
d.
e.
f.
g.
h.
Code Name of Taxing Jurisdictions Net Tax
State of Wisconsin
County
Captured explanation.
Municipality (Local)
Total Net Tax Rescinded or Refunded - EXCLUDING INTEREST
Personal Property Account No.
Year added to Tax Roll
Personal Property
7 Was the omitted tax offset by a related corresponding adjustment?a.If Yes,provide:
Was a chargeback form (PC-201) filed for this related parcel/account number?b.
Parcel/Account No. Tax Amount
Yes No
Yes No
19 0188
2018 2019 X MENOMONEE FALLS WAUKESHA 67 151
XMNFV H298
HUBBELL POWER SYSTEMS
.00 .00 .00
186,100.00
.00 307.16
.00 .00
1,083.89 67 3437 SCH D OF MENOMONEE FALLS 1,685.89 .00 00 0800 WAUKESHA COUNTY AREA TECH COLLEGE PEWA 58.84
3,135.78
X
X
PREVIOUSLY MANUFACTURING
Wisconsin Department of RevenuePC-205 (N. 10-10) R614B
9
10
11
12
NO
- 2 -
Qualify for equalization test?
DEPARTMENT OF REVENUE DETERMINATION
If "NO", notify tax district clerk that no action will be taken.
YES If "YES", continue.
NOWould the If "NO", notify tax district clerk that no action will be taken.
YES If "YES", we will:
equalizedvalue have been different?
EITHER
OR
Adjust the equalized value by $
and the equalized value by $
Allow the sharing of the omitted taxes to the taxing jurisdictions.
Explanation of Determination:
Certify results and issue instructions to the clerks of the tax district.
2018
X
X
X
X
A Manufacturing assessment was omitted form the assessment
roll and was not included in values provided for Equalized
Value. The omitted personal property assessment was not
corrected by an adjustment.
Request for Sharing of Non-Manufacturing Omitted Property Taxes
Wisconsin Department of RevenuePC-205 (N. 10-10) R614
See reverse side of form for DOR determination and explanation.
1
2
3
4
5
6
8
(Section 74.315, Wis. Stats.) DOR USE ONLY
Real Estate Parcel No.
Name of Property Owner
Real Estate
Year Tax Omitted
CASE NO.Town County Co Mun Code
TID # (if applicable):
Village City of
Omitted Assessed Value
Class(a)
Land(b)
Improvement(c)
Total (a + b)
Totals
Omitted Value
Net Omitted Taxes to be Shared With Taxing Jurisdictions - EXCLUDING INTEREST
a.
b.
c.1
c.2
d.
e.
f.
g.
h.
Code Name of Taxing Jurisdictions Net Tax
State of Wisconsin
County
Captured explanation.
Municipality (Local)
Total Net Tax Rescinded or Refunded - EXCLUDING INTEREST
Personal Property Account No.
Year added to Tax Roll
Personal Property
7 Was the omitted tax offset by a related corresponding adjustment?a.If Yes,provide:
Was a chargeback form (PC-201) filed for this related parcel/account number?b.
Parcel/Account No. Tax Amount
Yes No
Yes No
19 0014
2018 2019 XWAUKESHA WAUKESHA 67 291
X190160
FOLLETT HIGHER EDUCATION GROUP
.00 .00 .00
600.00
.00 1.05
.00 .00
6.19 67 6174 SCH D OF WAUKESHA 4.31 .00 00 0800 WAUKESHA COUNTY AREA TECH COLLEGE PEWA .20
11.75
X
X
PP equipment was missed and not processed.
Wisconsin Department of RevenuePC-205 (N. 10-10) R614B
9
10
11
12
NO
- 2 -
Qualify for equalization test?
DEPARTMENT OF REVENUE DETERMINATION
If "NO", notify tax district clerk that no action will be taken.
YES If "YES", continue.
NOWould the If "NO", notify tax district clerk that no action will be taken.
YES If "YES", we will:
equalizedvalue have been different?
EITHER
OR
Adjust the equalized value by $
and the equalized value by $
Allow the sharing of the omitted taxes to the taxing jurisdictions.
Explanation of Determination:
Certify results and issue instructions to the clerks of the tax district.
2018
X
X
X
Request for Sharing of Non-Manufacturing Omitted Property Taxes
Wisconsin Department of RevenuePC-205 (N. 10-10) R614
See reverse side of form for DOR determination and explanation.
1
2
3
4
5
6
8
(Section 74.315, Wis. Stats.) DOR USE ONLY
Real Estate Parcel No.
Name of Property Owner
Real Estate
Year Tax Omitted
CASE NO.Town County Co Mun Code
TID # (if applicable):
Village City of
Omitted Assessed Value
Class(a)
Land(b)
Improvement(c)
Total (a + b)
Totals
Omitted Value
Net Omitted Taxes to be Shared With Taxing Jurisdictions - EXCLUDING INTEREST
a.
b.
c.1
c.2
d.
e.
f.
g.
h.
Code Name of Taxing Jurisdictions Net Tax
State of Wisconsin
County
Captured explanation.
Municipality (Local)
Total Net Tax Rescinded or Refunded - EXCLUDING INTEREST
Personal Property Account No.
Year added to Tax Roll
Personal Property
7 Was the omitted tax offset by a related corresponding adjustment?a.If Yes,provide:
Was a chargeback form (PC-201) filed for this related parcel/account number?b.
Parcel/Account No. Tax Amount
Yes No
Yes No
19 0015
2018 2019 XWAUKESHA WAUKESHA 67 291
X133750
GREATAMERICA FINANCIAL SERVICES
.00 .00 .00
52,700.00
.00 91.80
.00 .00
543.34 67 6174 SCH D OF WAUKESHA 378.74 .00 00 0800 WAUKESHA COUNTY AREA TECH COLLEGE PEWA 17.58
1,031.46
X
X
Business reported personal property to the incorrect jurisdiction.
Wisconsin Department of RevenuePC-205 (N. 10-10) R614B
9
10
11
12
NO
- 2 -
Qualify for equalization test?
DEPARTMENT OF REVENUE DETERMINATION
If "NO", notify tax district clerk that no action will be taken.
YES If "YES", continue.
NOWould the If "NO", notify tax district clerk that no action will be taken.
YES If "YES", we will:
equalizedvalue have been different?
EITHER
OR
Adjust the equalized value by $
and the equalized value by $
Allow the sharing of the omitted taxes to the taxing jurisdictions.
Explanation of Determination:
Certify results and issue instructions to the clerks of the tax district.
2018
X
X
X
Request for Sharing of Non-Manufacturing Omitted Property Taxes
Wisconsin Department of RevenuePC-205 (N. 10-10) R614
See reverse side of form for DOR determination and explanation.
1
2
3
4
5
6
8
(Section 74.315, Wis. Stats.) DOR USE ONLY
Real Estate Parcel No.
Name of Property Owner
Real Estate
Year Tax Omitted
CASE NO.Town County Co Mun Code
TID # (if applicable):
Village City of
Omitted Assessed Value
Class(a)
Land(b)
Improvement(c)
Total (a + b)
Totals
Omitted Value
Net Omitted Taxes to be Shared With Taxing Jurisdictions - EXCLUDING INTEREST
a.
b.
c.1
c.2
d.
e.
f.
g.
h.
Code Name of Taxing Jurisdictions Net Tax
State of Wisconsin
County
Captured explanation.
Municipality (Local)
Total Net Tax Rescinded or Refunded - EXCLUDING INTEREST
Personal Property Account No.
Year added to Tax Roll
Personal Property
7 Was the omitted tax offset by a related corresponding adjustment?a.If Yes,provide:
Was a chargeback form (PC-201) filed for this related parcel/account number?b.
Parcel/Account No. Tax Amount
Yes No
Yes No
19 0016
2018 2019 XWAUKESHA WAUKESHA 67 291
X195090
CIT BANK NA
.00 .00 .00
16,600.00
.00 28.91
.00 .00
171.15 67 6174 SCH D OF WAUKESHA 119.30 .00 00 0800 WAUKESHA COUNTY AREA TECH COLLEGE PEWA 5.54
324.90
X
X
The asset was not reported on the 2018 personal property form by the business.
Wisconsin Department of RevenuePC-205 (N. 10-10) R614B
9
10
11
12
NO
- 2 -
Qualify for equalization test?
DEPARTMENT OF REVENUE DETERMINATION
If "NO", notify tax district clerk that no action will be taken.
YES If "YES", continue.
NOWould the If "NO", notify tax district clerk that no action will be taken.
YES If "YES", we will:
equalizedvalue have been different?
EITHER
OR
Adjust the equalized value by $
and the equalized value by $
Allow the sharing of the omitted taxes to the taxing jurisdictions.
Explanation of Determination:
Certify results and issue instructions to the clerks of the tax district.
2018
X
X
X
Request for Sharing of Non-Manufacturing Omitted Property Taxes
Wisconsin Department of RevenuePC-205 (N. 10-10) R614
See reverse side of form for DOR determination and explanation.
1
2
3
4
5
6
8
(Section 74.315, Wis. Stats.) DOR USE ONLY
Real Estate Parcel No.
Name of Property Owner
Real Estate
Year Tax Omitted
CASE NO.Town County Co Mun Code
TID # (if applicable):
Village City of
Omitted Assessed Value
Class(a)
Land(b)
Improvement(c)
Total (a + b)
Totals
Omitted Value
Net Omitted Taxes to be Shared With Taxing Jurisdictions - EXCLUDING INTEREST
a.
b.
c.1
c.2
d.
e.
f.
g.
h.
Code Name of Taxing Jurisdictions Net Tax
State of Wisconsin
County
Captured explanation.
Municipality (Local)
Total Net Tax Rescinded or Refunded - EXCLUDING INTEREST
Personal Property Account No.
Year added to Tax Roll
Personal Property
7 Was the omitted tax offset by a related corresponding adjustment?a.If Yes,provide:
Was a chargeback form (PC-201) filed for this related parcel/account number?b.
Parcel/Account No. Tax Amount
Yes No
Yes No
19 0017
2018 2019 XWAUKESHA WAUKESHA 67 291
X195390
J PALLETS LLC RACQUEL CHAVEZ
.00 .00 .00
2,300.00
.00 4.01
.00 .00
23.71 67 6174 SCH D OF WAUKESHA 16.53 .00 00 0800 WAUKESHA COUNTY AREA TECH COLLEGE PEWA .77
45.02
X
X
PP form was turned in late and doomaged assessment was lower than actual reported assessment.
Wisconsin Department of RevenuePC-205 (N. 10-10) R614B
9
10
11
12
NO
- 2 -
Qualify for equalization test?
DEPARTMENT OF REVENUE DETERMINATION
If "NO", notify tax district clerk that no action will be taken.
YES If "YES", continue.
NOWould the If "NO", notify tax district clerk that no action will be taken.
YES If "YES", we will:
equalizedvalue have been different?
EITHER
OR
Adjust the equalized value by $
and the equalized value by $
Allow the sharing of the omitted taxes to the taxing jurisdictions.
Explanation of Determination:
Certify results and issue instructions to the clerks of the tax district.
2018
X
X
X
Request for Sharing of Non-Manufacturing Omitted Property Taxes
Wisconsin Department of RevenuePC-205 (N. 10-10) R614
See reverse side of form for DOR determination and explanation.
1
2
3
4
5
6
8
(Section 74.315, Wis. Stats.) DOR USE ONLY
Real Estate Parcel No.
Name of Property Owner
Real Estate
Year Tax Omitted
CASE NO.Town County Co Mun Code
TID # (if applicable):
Village City of
Omitted Assessed Value
Class(a)
Land(b)
Improvement(c)
Total (a + b)
Totals
Omitted Value
Net Omitted Taxes to be Shared With Taxing Jurisdictions - EXCLUDING INTEREST
a.
b.
c.1
c.2
d.
e.
f.
g.
h.
Code Name of Taxing Jurisdictions Net Tax
State of Wisconsin
County
Captured explanation.
Municipality (Local)
Total Net Tax Rescinded or Refunded - EXCLUDING INTEREST
Personal Property Account No.
Year added to Tax Roll
Personal Property
7 Was the omitted tax offset by a related corresponding adjustment?a.If Yes,provide:
Was a chargeback form (PC-201) filed for this related parcel/account number?b.
Parcel/Account No. Tax Amount
Yes No
Yes No
19 0018
2018 2019 XWAUKESHA WAUKESHA 67 291
X199640 022
BAYER HEALTHCARE LLC
.00 .00 .00
9,900.00
.00 17.24
.00 .00
102.07 67 6174 SCH D OF WAUKESHA 71.15 .00 00 0800 WAUKESHA COUNTY AREA TECH COLLEGE PEWA 3.30
193.76
X
X
PP form had incorrect Pewaukee address of equipment when it was actually in Waukesha City.
Wisconsin Department of RevenuePC-205 (N. 10-10) R614B
9
10
11
12
NO
- 2 -
Qualify for equalization test?
DEPARTMENT OF REVENUE DETERMINATION
If "NO", notify tax district clerk that no action will be taken.
YES If "YES", continue.
NOWould the If "NO", notify tax district clerk that no action will be taken.
YES If "YES", we will:
equalizedvalue have been different?
EITHER
OR
Adjust the equalized value by $
and the equalized value by $
Allow the sharing of the omitted taxes to the taxing jurisdictions.
Explanation of Determination:
Certify results and issue instructions to the clerks of the tax district.
2018
X
X
X
Request for Sharing of Non-Manufacturing Omitted Property Taxes
Wisconsin Department of RevenuePC-205 (N. 10-10) R614
See reverse side of form for DOR determination and explanation.
1
2
3
4
5
6
8
(Section 74.315, Wis. Stats.) DOR USE ONLY
Real Estate Parcel No.
Name of Property Owner
Real Estate
Year Tax Omitted
CASE NO.Town County Co Mun Code
TID # (if applicable):
Village City of
Omitted Assessed Value
Class(a)
Land(b)
Improvement(c)
Total (a + b)
Totals
Omitted Value
Net Omitted Taxes to be Shared With Taxing Jurisdictions - EXCLUDING INTEREST
a.
b.
c.1
c.2
d.
e.
f.
g.
h.
Code Name of Taxing Jurisdictions Net Tax
State of Wisconsin
County
Captured explanation.
Municipality (Local)
Total Net Tax Rescinded or Refunded - EXCLUDING INTEREST
Personal Property Account No.
Year added to Tax Roll
Personal Property
7 Was the omitted tax offset by a related corresponding adjustment?a.If Yes,provide:
Was a chargeback form (PC-201) filed for this related parcel/account number?b.
Parcel/Account No. Tax Amount
Yes No
Yes No
19 0079
2018 2019 XNEW LONDON WAUPACA 68 261
X33 00 147
COPPERSMITH FOODS INC
.00 .00 .00
1,103,400.00
.00 6,732.43
.00 .00
9,155.67 68 3955 SCH D OF NEW LONDON 7,891.11 .00 00 1200 FOX VALLEY TECHNICAL COLLEGE APPL 1,078.16
24,857.37
X
X
Personal Property Assets were claimed as "Exempt Machinery, tools and patterns". Were found to be 'Equipment' - not machinery tools and patterns.
Wisconsin Department of RevenuePC-205 (N. 10-10) R614B
9
10
11
12
NO
- 2 -
Qualify for equalization test?
DEPARTMENT OF REVENUE DETERMINATION
If "NO", notify tax district clerk that no action will be taken.
YES If "YES", continue.
NOWould the If "NO", notify tax district clerk that no action will be taken.
YES If "YES", we will:
equalizedvalue have been different?
EITHER
OR
Adjust the equalized value by $
and the equalized value by $
Allow the sharing of the omitted taxes to the taxing jurisdictions.
Explanation of Determination:
Certify results and issue instructions to the clerks of the tax district.
2018
X
X
X
X
Personal property was omitted from the assessment roll and
not included on the Municipal Assessment Report. The
Equalized Value was impacted. PMG
Request for Sharing of Non-Manufacturing Omitted Property Taxes
Wisconsin Department of RevenuePC-205 (N. 10-10) R614
See reverse side of form for DOR determination and explanation.
1
2
3
4
5
6
8
(Section 74.315, Wis. Stats.) DOR USE ONLY
Real Estate Parcel No.
Name of Property Owner
Real Estate
Year Tax Omitted
CASE NO.Town County Co Mun Code
TID # (if applicable):
Village City of
Omitted Assessed Value
Class(a)
Land(b)
Improvement(c)
Total (a + b)
Totals
Omitted Value
Net Omitted Taxes to be Shared With Taxing Jurisdictions - EXCLUDING INTEREST
a.
b.
c.1
c.2
d.
e.
f.
g.
h.
Code Name of Taxing Jurisdictions Net Tax
State of Wisconsin
County
Captured explanation.
Municipality (Local)
Total Net Tax Rescinded or Refunded - EXCLUDING INTEREST
Personal Property Account No.
Year added to Tax Roll
Personal Property
7 Was the omitted tax offset by a related corresponding adjustment?a.If Yes,provide:
Was a chargeback form (PC-201) filed for this related parcel/account number?b.
Parcel/Account No. Tax Amount
Yes No
Yes No
19 0139
2017 2018X OMRO WINNEBAGO 70 016
X 016-036808
NICHOLAS R AND BRENDA E GRAMS
1 .00 339,400.00 339,400.00
.00 339,400.00 339,400.00
.00 1,957.95
70 7010 ALGOMA SANITARY DISTRICT #1 91.36 .00
561.17 70 4088 SCH D OF OMRO 2,896.69 .00 00 1200 FOX VALLEY TECHNICAL COLLEGE APPL 369.76
5,876.93
X
X
The home owner moved into the home in 2014 however the assessor never received a permit stating that this home was built. The omission was corrected in 2018 and we are asking to go back one year - 2017 to collect the property taxes.
Wisconsin Department of RevenuePC-205 (N. 10-10) R614B
9
10
11
12
NO
- 2 -
Qualify for equalization test?
DEPARTMENT OF REVENUE DETERMINATION
If "NO", notify tax district clerk that no action will be taken.
YES If "YES", continue.
NOWould the If "NO", notify tax district clerk that no action will be taken.
YES If "YES", we will:
equalizedvalue have been different?
EITHER
OR
Adjust the equalized value by $
and the equalized value by $
Allow the sharing of the omitted taxes to the taxing jurisdictions.
Explanation of Determination:
Certify results and issue instructions to the clerks of the tax district.
2017
X
X
X
X
New construction was omitted from the assessment roll and
not included on the Municipal Assessment Report. Therefore
the Equalized Value was impacted. PMG
Request for Sharing of Non-Manufacturing Omitted Property Taxes
Wisconsin Department of RevenuePC-205 (N. 10-10) R614
See reverse side of form for DOR determination and explanation.
1
2
3
4
5
6
8
(Section 74.315, Wis. Stats.) DOR USE ONLY
Real Estate Parcel No.
Name of Property Owner
Real Estate
Year Tax Omitted
CASE NO.Town County Co Mun Code
TID # (if applicable):
Village City of
Omitted Assessed Value
Class(a)
Land(b)
Improvement(c)
Total (a + b)
Totals
Omitted Value
Net Omitted Taxes to be Shared With Taxing Jurisdictions - EXCLUDING INTEREST
a.
b.
c.1
c.2
d.
e.
f.
g.
h.
Code Name of Taxing Jurisdictions Net Tax
State of Wisconsin
County
Captured explanation.
Municipality (Local)
Total Net Tax Rescinded or Refunded - EXCLUDING INTEREST
Personal Property Account No.
Year added to Tax Roll
Personal Property
7 Was the omitted tax offset by a related corresponding adjustment?a.If Yes,provide:
Was a chargeback form (PC-201) filed for this related parcel/account number?b.
Parcel/Account No. Tax Amount
Yes No
Yes No
19 0091
2018 2019 X FOX CROSSING WINNEBAGO 70 121
X121-P0727
BALLARD MARINE CONSTRUCTION LLC
.00 .00 .00
423,200.00
.00 2,146.01
.00 .00
2,257.55 70 3892 SCH D OF NEENAH 2,790.17 .00 00 1200 FOX VALLEY TECHNICAL COLLEGE APPL 413.18
7,606.91
X
X
The Village Assessor received a late personal property tax statement on a new leased parcel.
Wisconsin Department of RevenuePC-205 (N. 10-10) R614B
9
10
11
12
NO
- 2 -
Qualify for equalization test?
DEPARTMENT OF REVENUE DETERMINATION
If "NO", notify tax district clerk that no action will be taken.
YES If "YES", continue.
NOWould the If "NO", notify tax district clerk that no action will be taken.
YES If "YES", we will:
equalizedvalue have been different?
EITHER
OR
Adjust the equalized value by $
and the equalized value by $
Allow the sharing of the omitted taxes to the taxing jurisdictions.
Explanation of Determination:
Certify results and issue instructions to the clerks of the tax district.
2018
X
X
X
X
Personal property was omitted from the assessment roll and
not included on the Munipical Assessment Report. The
Equalized Value is impacted. PMG
Request for Sharing of Non-Manufacturing Omitted Property Taxes
Wisconsin Department of RevenuePC-205 (N. 10-10) R614
See reverse side of form for DOR determination and explanation.
1
2
3
4
5
6
8
(Section 74.315, Wis. Stats.) DOR USE ONLY
Real Estate Parcel No.
Name of Property Owner
Real Estate
Year Tax Omitted
CASE NO.Town County Co Mun Code
TID # (if applicable):
Village City of
Omitted Assessed Value
Class(a)
Land(b)
Improvement(c)
Total (a + b)
Totals
Omitted Value
Net Omitted Taxes to be Shared With Taxing Jurisdictions - EXCLUDING INTEREST
a.
b.
c.1
c.2
d.
e.
f.
g.
h.
Code Name of Taxing Jurisdictions Net Tax
State of Wisconsin
County
Captured explanation.
Municipality (Local)
Total Net Tax Rescinded or Refunded - EXCLUDING INTEREST
Personal Property Account No.
Year added to Tax Roll
Personal Property
7 Was the omitted tax offset by a related corresponding adjustment?a.If Yes,provide:
Was a chargeback form (PC-201) filed for this related parcel/account number?b.
Parcel/Account No. Tax Amount
Yes No
Yes No
19 0092
2018 2019 X FOX CROSSING WINNEBAGO 70 121
X 121-0004-09-02
LOPEZ INVESTMENTS LLC
2 69,900.00 543,600.00 613,500.00
69,900.00 543,600.00 613,500.00
.00 3,165.90
.00 .00
3,207.07 70 3430 SCH D OF MENASHA 6,932.35 .00 00 1200 FOX VALLEY TECHNICAL COLLEGE APPL 609.54
13,914.86
X
X
A small portion of this parcel went into a transportation plat (so small it does not even affect the value); however, the entire parcel was incorrectly made exempt for 2018.
Wisconsin Department of RevenuePC-205 (N. 10-10) R614B
9
10
11
12
NO
- 2 -
Qualify for equalization test?
DEPARTMENT OF REVENUE DETERMINATION
If "NO", notify tax district clerk that no action will be taken.
YES If "YES", continue.
NOWould the If "NO", notify tax district clerk that no action will be taken.
YES If "YES", we will:
equalizedvalue have been different?
EITHER
OR
Adjust the equalized value by $
and the equalized value by $
Allow the sharing of the omitted taxes to the taxing jurisdictions.
Explanation of Determination:
Certify results and issue instructions to the clerks of the tax district.
2018
X
X
X
X
Previously assessed real property was erroneously determined
to be exempt. The property was reported on the Municipal
Assessment Report as "formerly taxable, now exempt" which
impacted the Equalized Value. PMG