142
Request for Sharing of Non-Manufacturing Omitted Property Taxes Wisconsin Department of Revenue PC-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 Municipality (Local) Total Net Tax Rescinded or Refunded - EXCLUDING INTEREST Personal Property Account No. Year added to Tax Roll Personal Property 7 Was the omitted tax offset by a related corresponding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 2017 2018 X LINCOLN ADAMS 01 016 X 016-09030-0000 LIQUID POWER SPECIALTY PRODUCTS X X

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Page 1: Request for Sharing of Non-Manufacturing Omitted Property ... · Request for Sharing of Non-Manufacturing Omitted Property Taxes ×Ã`òðõ@MÕK@ñð`ñð]@@@Ùöñô æ ¢ ¢ @Ä

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Total Net Tax Rescinded or Refunded - EXCLUDING INTEREST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

Page 2: Request for Sharing of Non-Manufacturing Omitted Property ... · Request for Sharing of Non-Manufacturing Omitted Property Taxes ×Ã`òðõ@MÕK@ñð`ñð]@@@Ùöñô æ ¢ ¢ @Ä

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

Page 3: Request for Sharing of Non-Manufacturing Omitted Property ... · Request for Sharing of Non-Manufacturing Omitted Property Taxes ×Ã`òðõ@MÕK@ñð`ñð]@@@Ùöñô æ ¢ ¢ @Ä

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.

Page 4: Request for Sharing of Non-Manufacturing Omitted Property ... · Request for Sharing of Non-Manufacturing Omitted Property Taxes ×Ã`òðõ@MÕK@ñð`ñð]@@@Ùöñô æ ¢ ¢ @Ä

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.

Page 5: Request for Sharing of Non-Manufacturing Omitted Property ... · Request for Sharing of Non-Manufacturing Omitted Property Taxes ×Ã`òðõ@MÕK@ñð`ñð]@@@Ùöñô æ ¢ ¢ @Ä

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.

Page 6: Request for Sharing of Non-Manufacturing Omitted Property ... · Request for Sharing of Non-Manufacturing Omitted Property Taxes ×Ã`òðõ@MÕK@ñð`ñð]@@@Ùöñô æ ¢ ¢ @Ä

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.

Page 7: Request for Sharing of Non-Manufacturing Omitted Property ... · Request for Sharing of Non-Manufacturing Omitted Property Taxes ×Ã`òðõ@MÕK@ñð`ñð]@@@Ùöñô æ ¢ ¢ @Ä

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.

Page 8: Request for Sharing of Non-Manufacturing Omitted Property ... · Request for Sharing of Non-Manufacturing Omitted Property Taxes ×Ã`òðõ@MÕK@ñð`ñð]@@@Ùöñô æ ¢ ¢ @Ä

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

Page 9: Request for Sharing of Non-Manufacturing Omitted Property ... · Request for Sharing of Non-Manufacturing Omitted Property Taxes ×Ã`òðõ@MÕK@ñð`ñð]@@@Ùöñô æ ¢ ¢ @Ä

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.

Page 10: Request for Sharing of Non-Manufacturing Omitted Property ... · Request for Sharing of Non-Manufacturing Omitted Property Taxes ×Ã`òðõ@MÕK@ñð`ñð]@@@Ùöñô æ ¢ ¢ @Ä

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

Page 11: Request for Sharing of Non-Manufacturing Omitted Property ... · Request for Sharing of Non-Manufacturing Omitted Property Taxes ×Ã`òðõ@MÕK@ñð`ñð]@@@Ùöñô æ ¢ ¢ @Ä

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.

Page 12: Request for Sharing of Non-Manufacturing Omitted Property ... · Request for Sharing of Non-Manufacturing Omitted Property Taxes ×Ã`òðõ@MÕK@ñð`ñð]@@@Ùöñô æ ¢ ¢ @Ä

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.

Page 13: Request for Sharing of Non-Manufacturing Omitted Property ... · Request for Sharing of Non-Manufacturing Omitted Property Taxes ×Ã`òðõ@MÕK@ñð`ñð]@@@Ùöñô æ ¢ ¢ @Ä

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.

Page 14: Request for Sharing of Non-Manufacturing Omitted Property ... · Request for Sharing of Non-Manufacturing Omitted Property Taxes ×Ã`òðõ@MÕK@ñð`ñð]@@@Ùöñô æ ¢ ¢ @Ä

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.

Page 15: Request for Sharing of Non-Manufacturing Omitted Property ... · Request for Sharing of Non-Manufacturing Omitted Property Taxes ×Ã`òðõ@MÕK@ñð`ñð]@@@Ùöñô æ ¢ ¢ @Ä

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.

Page 16: Request for Sharing of Non-Manufacturing Omitted Property ... · Request for Sharing of Non-Manufacturing Omitted Property Taxes ×Ã`òðõ@MÕK@ñð`ñð]@@@Ùöñô æ ¢ ¢ @Ä

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.

Page 17: Request for Sharing of Non-Manufacturing Omitted Property ... · Request for Sharing of Non-Manufacturing Omitted Property Taxes ×Ã`òðõ@MÕK@ñð`ñð]@@@Ùöñô æ ¢ ¢ @Ä

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.

Page 18: Request for Sharing of Non-Manufacturing Omitted Property ... · Request for Sharing of Non-Manufacturing Omitted Property Taxes ×Ã`òðõ@MÕK@ñð`ñð]@@@Ùöñô æ ¢ ¢ @Ä

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.

Page 19: Request for Sharing of Non-Manufacturing Omitted Property ... · Request for Sharing of Non-Manufacturing Omitted Property Taxes ×Ã`òðõ@MÕK@ñð`ñð]@@@Ùöñô æ ¢ ¢ @Ä

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

Page 20: Request for Sharing of Non-Manufacturing Omitted Property ... · Request for Sharing of Non-Manufacturing Omitted Property Taxes ×Ã`òðõ@MÕK@ñð`ñð]@@@Ùöñô æ ¢ ¢ @Ä

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.

Page 21: Request for Sharing of Non-Manufacturing Omitted Property ... · Request for Sharing of Non-Manufacturing Omitted Property Taxes ×Ã`òðõ@MÕK@ñð`ñð]@@@Ùöñô æ ¢ ¢ @Ä

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

Page 22: Request for Sharing of Non-Manufacturing Omitted Property ... · Request for Sharing of Non-Manufacturing Omitted Property Taxes ×Ã`òðõ@MÕK@ñð`ñð]@@@Ùöñô æ ¢ ¢ @Ä

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.

Page 23: Request for Sharing of Non-Manufacturing Omitted Property ... · Request for Sharing of Non-Manufacturing Omitted Property Taxes ×Ã`òðõ@MÕK@ñð`ñð]@@@Ùöñô æ ¢ ¢ @Ä

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.

Page 24: Request for Sharing of Non-Manufacturing Omitted Property ... · Request for Sharing of Non-Manufacturing Omitted Property Taxes ×Ã`òðõ@MÕK@ñð`ñð]@@@Ùöñô æ ¢ ¢ @Ä

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.

Page 25: Request for Sharing of Non-Manufacturing Omitted Property ... · Request for Sharing of Non-Manufacturing Omitted Property Taxes ×Ã`òðõ@MÕK@ñð`ñð]@@@Ùöñô æ ¢ ¢ @Ä

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

Page 26: Request for Sharing of Non-Manufacturing Omitted Property ... · Request for Sharing of Non-Manufacturing Omitted Property Taxes ×Ã`òðõ@MÕK@ñð`ñð]@@@Ùöñô æ ¢ ¢ @Ä

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.

Page 27: Request for Sharing of Non-Manufacturing Omitted Property ... · Request for Sharing of Non-Manufacturing Omitted Property Taxes ×Ã`òðõ@MÕK@ñð`ñð]@@@Ùöñô æ ¢ ¢ @Ä

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

Page 28: Request for Sharing of Non-Manufacturing Omitted Property ... · Request for Sharing of Non-Manufacturing Omitted Property Taxes ×Ã`òðõ@MÕK@ñð`ñð]@@@Ùöñô æ ¢ ¢ @Ä

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.

Page 29: Request for Sharing of Non-Manufacturing Omitted Property ... · Request for Sharing of Non-Manufacturing Omitted Property Taxes ×Ã`òðõ@MÕK@ñð`ñð]@@@Ùöñô æ ¢ ¢ @Ä

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

Page 30: Request for Sharing of Non-Manufacturing Omitted Property ... · Request for Sharing of Non-Manufacturing Omitted Property Taxes ×Ã`òðõ@MÕK@ñð`ñð]@@@Ùöñô æ ¢ ¢ @Ä

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.

Page 31: Request for Sharing of Non-Manufacturing Omitted Property ... · Request for Sharing of Non-Manufacturing Omitted Property Taxes ×Ã`òðõ@MÕK@ñð`ñð]@@@Ùöñô æ ¢ ¢ @Ä

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

Page 32: Request for Sharing of Non-Manufacturing Omitted Property ... · Request for Sharing of Non-Manufacturing Omitted Property Taxes ×Ã`òðõ@MÕK@ñð`ñð]@@@Ùöñô æ ¢ ¢ @Ä

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.

Page 33: Request for Sharing of Non-Manufacturing Omitted Property ... · Request for Sharing of Non-Manufacturing Omitted Property Taxes ×Ã`òðõ@MÕK@ñð`ñð]@@@Ùöñô æ ¢ ¢ @Ä

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

Page 34: Request for Sharing of Non-Manufacturing Omitted Property ... · Request for Sharing of Non-Manufacturing Omitted Property Taxes ×Ã`òðõ@MÕK@ñð`ñð]@@@Ùöñô æ ¢ ¢ @Ä

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.

Page 35: Request for Sharing of Non-Manufacturing Omitted Property ... · Request for Sharing of Non-Manufacturing Omitted Property Taxes ×Ã`òðõ@MÕK@ñð`ñð]@@@Ùöñô æ ¢ ¢ @Ä

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.

Page 36: Request for Sharing of Non-Manufacturing Omitted Property ... · Request for Sharing of Non-Manufacturing Omitted Property Taxes ×Ã`òðõ@MÕK@ñð`ñð]@@@Ùöñô æ ¢ ¢ @Ä

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

Page 37: Request for Sharing of Non-Manufacturing Omitted Property ... · Request for Sharing of Non-Manufacturing Omitted Property Taxes ×Ã`òðõ@MÕK@ñð`ñð]@@@Ùöñô æ ¢ ¢ @Ä

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.

Page 38: Request for Sharing of Non-Manufacturing Omitted Property ... · Request for Sharing of Non-Manufacturing Omitted Property Taxes ×Ã`òðõ@MÕK@ñð`ñð]@@@Ùöñô æ ¢ ¢ @Ä

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

Page 39: Request for Sharing of Non-Manufacturing Omitted Property ... · Request for Sharing of Non-Manufacturing Omitted Property Taxes ×Ã`òðõ@MÕK@ñð`ñð]@@@Ùöñô æ ¢ ¢ @Ä

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.

Page 40: Request for Sharing of Non-Manufacturing Omitted Property ... · Request for Sharing of Non-Manufacturing Omitted Property Taxes ×Ã`òðõ@MÕK@ñð`ñð]@@@Ùöñô æ ¢ ¢ @Ä

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

Page 41: Request for Sharing of Non-Manufacturing Omitted Property ... · Request for Sharing of Non-Manufacturing Omitted Property Taxes ×Ã`òðõ@MÕK@ñð`ñð]@@@Ùöñô æ ¢ ¢ @Ä

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.

Page 42: Request for Sharing of Non-Manufacturing Omitted Property ... · Request for Sharing of Non-Manufacturing Omitted Property Taxes ×Ã`òðõ@MÕK@ñð`ñð]@@@Ùöñô æ ¢ ¢ @Ä

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

Page 43: Request for Sharing of Non-Manufacturing Omitted Property ... · Request for Sharing of Non-Manufacturing Omitted Property Taxes ×Ã`òðõ@MÕK@ñð`ñð]@@@Ùöñô æ ¢ ¢ @Ä

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.

Page 44: Request for Sharing of Non-Manufacturing Omitted Property ... · Request for Sharing of Non-Manufacturing Omitted Property Taxes ×Ã`òðõ@MÕK@ñð`ñð]@@@Ùöñô æ ¢ ¢ @Ä

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

Page 45: Request for Sharing of Non-Manufacturing Omitted Property ... · Request for Sharing of Non-Manufacturing Omitted Property Taxes ×Ã`òðõ@MÕK@ñð`ñð]@@@Ùöñô æ ¢ ¢ @Ä

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.

Page 46: Request for Sharing of Non-Manufacturing Omitted Property ... · Request for Sharing of Non-Manufacturing Omitted Property Taxes ×Ã`òðõ@MÕK@ñð`ñð]@@@Ùöñô æ ¢ ¢ @Ä

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.

Page 47: Request for Sharing of Non-Manufacturing Omitted Property ... · Request for Sharing of Non-Manufacturing Omitted Property Taxes ×Ã`òðõ@MÕK@ñð`ñð]@@@Ùöñô æ ¢ ¢ @Ä

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.

Page 48: Request for Sharing of Non-Manufacturing Omitted Property ... · Request for Sharing of Non-Manufacturing Omitted Property Taxes ×Ã`òðõ@MÕK@ñð`ñð]@@@Ùöñô æ ¢ ¢ @Ä

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.

Page 49: Request for Sharing of Non-Manufacturing Omitted Property ... · Request for Sharing of Non-Manufacturing Omitted Property Taxes ×Ã`òðõ@MÕK@ñð`ñð]@@@Ùöñô æ ¢ ¢ @Ä

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

Page 50: Request for Sharing of Non-Manufacturing Omitted Property ... · Request for Sharing of Non-Manufacturing Omitted Property Taxes ×Ã`òðõ@MÕK@ñð`ñð]@@@Ùöñô æ ¢ ¢ @Ä

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

Page 51: Request for Sharing of Non-Manufacturing Omitted Property ... · Request for Sharing of Non-Manufacturing Omitted Property Taxes ×Ã`òðõ@MÕK@ñð`ñð]@@@Ùöñô æ ¢ ¢ @Ä

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.

Page 52: Request for Sharing of Non-Manufacturing Omitted Property ... · Request for Sharing of Non-Manufacturing Omitted Property Taxes ×Ã`òðõ@MÕK@ñð`ñð]@@@Ùöñô æ ¢ ¢ @Ä

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

Page 53: Request for Sharing of Non-Manufacturing Omitted Property ... · Request for Sharing of Non-Manufacturing Omitted Property Taxes ×Ã`òðõ@MÕK@ñð`ñð]@@@Ùöñô æ ¢ ¢ @Ä

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.

Page 54: Request for Sharing of Non-Manufacturing Omitted Property ... · Request for Sharing of Non-Manufacturing Omitted Property Taxes ×Ã`òðõ@MÕK@ñð`ñð]@@@Ùöñô æ ¢ ¢ @Ä

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

Page 55: Request for Sharing of Non-Manufacturing Omitted Property ... · Request for Sharing of Non-Manufacturing Omitted Property Taxes ×Ã`òðõ@MÕK@ñð`ñð]@@@Ùöñô æ ¢ ¢ @Ä

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

Page 56: Request for Sharing of Non-Manufacturing Omitted Property ... · Request for Sharing of Non-Manufacturing Omitted Property Taxes ×Ã`òðõ@MÕK@ñð`ñð]@@@Ùöñô æ ¢ ¢ @Ä

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.

Page 57: Request for Sharing of Non-Manufacturing Omitted Property ... · Request for Sharing of Non-Manufacturing Omitted Property Taxes ×Ã`òðõ@MÕK@ñð`ñð]@@@Ùöñô æ ¢ ¢ @Ä

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

Page 58: Request for Sharing of Non-Manufacturing Omitted Property ... · Request for Sharing of Non-Manufacturing Omitted Property Taxes ×Ã`òðõ@MÕK@ñð`ñð]@@@Ùöñô æ ¢ ¢ @Ä

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.

Page 59: Request for Sharing of Non-Manufacturing Omitted Property ... · Request for Sharing of Non-Manufacturing Omitted Property Taxes ×Ã`òðõ@MÕK@ñð`ñð]@@@Ùöñô æ ¢ ¢ @Ä

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

Page 60: Request for Sharing of Non-Manufacturing Omitted Property ... · Request for Sharing of Non-Manufacturing Omitted Property Taxes ×Ã`òðõ@MÕK@ñð`ñð]@@@Ùöñô æ ¢ ¢ @Ä

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.

Page 61: Request for Sharing of Non-Manufacturing Omitted Property ... · Request for Sharing of Non-Manufacturing Omitted Property Taxes ×Ã`òðõ@MÕK@ñð`ñð]@@@Ùöñô æ ¢ ¢ @Ä

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

Page 62: Request for Sharing of Non-Manufacturing Omitted Property ... · Request for Sharing of Non-Manufacturing Omitted Property Taxes ×Ã`òðõ@MÕK@ñð`ñð]@@@Ùöñô æ ¢ ¢ @Ä

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.

Page 63: Request for Sharing of Non-Manufacturing Omitted Property ... · Request for Sharing of Non-Manufacturing Omitted Property Taxes ×Ã`òðõ@MÕK@ñð`ñð]@@@Ùöñô æ ¢ ¢ @Ä

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

Page 64: Request for Sharing of Non-Manufacturing Omitted Property ... · Request for Sharing of Non-Manufacturing Omitted Property Taxes ×Ã`òðõ@MÕK@ñð`ñð]@@@Ùöñô æ ¢ ¢ @Ä

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.

Page 65: Request for Sharing of Non-Manufacturing Omitted Property ... · Request for Sharing of Non-Manufacturing Omitted Property Taxes ×Ã`òðõ@MÕK@ñð`ñð]@@@Ùöñô æ ¢ ¢ @Ä

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

Page 66: Request for Sharing of Non-Manufacturing Omitted Property ... · Request for Sharing of Non-Manufacturing Omitted Property Taxes ×Ã`òðõ@MÕK@ñð`ñð]@@@Ùöñô æ ¢ ¢ @Ä

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.

Page 67: Request for Sharing of Non-Manufacturing Omitted Property ... · Request for Sharing of Non-Manufacturing Omitted Property Taxes ×Ã`òðõ@MÕK@ñð`ñð]@@@Ùöñô æ ¢ ¢ @Ä

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.

Page 68: Request for Sharing of Non-Manufacturing Omitted Property ... · Request for Sharing of Non-Manufacturing Omitted Property Taxes ×Ã`òðõ@MÕK@ñð`ñð]@@@Ùöñô æ ¢ ¢ @Ä

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.

Page 69: Request for Sharing of Non-Manufacturing Omitted Property ... · Request for Sharing of Non-Manufacturing Omitted Property Taxes ×Ã`òðõ@MÕK@ñð`ñð]@@@Ùöñô æ ¢ ¢ @Ä

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.

Page 70: Request for Sharing of Non-Manufacturing Omitted Property ... · Request for Sharing of Non-Manufacturing Omitted Property Taxes ×Ã`òðõ@MÕK@ñð`ñð]@@@Ùöñô æ ¢ ¢ @Ä

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

Page 71: Request for Sharing of Non-Manufacturing Omitted Property ... · Request for Sharing of Non-Manufacturing Omitted Property Taxes ×Ã`òðõ@MÕK@ñð`ñð]@@@Ùöñô æ ¢ ¢ @Ä

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.

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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

Page 73: Request for Sharing of Non-Manufacturing Omitted Property ... · Request for Sharing of Non-Manufacturing Omitted Property Taxes ×Ã`òðõ@MÕK@ñð`ñð]@@@Ùöñô æ ¢ ¢ @Ä

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

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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

Page 75: Request for Sharing of Non-Manufacturing Omitted Property ... · Request for Sharing of Non-Manufacturing Omitted Property Taxes ×Ã`òðõ@MÕK@ñð`ñð]@@@Ùöñô æ ¢ ¢ @Ä

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.

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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

Page 77: Request for Sharing of Non-Manufacturing Omitted Property ... · Request for Sharing of Non-Manufacturing Omitted Property Taxes ×Ã`òðõ@MÕK@ñð`ñð]@@@Ùöñô æ ¢ ¢ @Ä

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.

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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

Page 79: Request for Sharing of Non-Manufacturing Omitted Property ... · Request for Sharing of Non-Manufacturing Omitted Property Taxes ×Ã`òðõ@MÕK@ñð`ñð]@@@Ùöñô æ ¢ ¢ @Ä

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.

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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

Page 81: Request for Sharing of Non-Manufacturing Omitted Property ... · Request for Sharing of Non-Manufacturing Omitted Property Taxes ×Ã`òðõ@MÕK@ñð`ñð]@@@Ùöñô æ ¢ ¢ @Ä

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.

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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.

Page 83: Request for Sharing of Non-Manufacturing Omitted Property ... · Request for Sharing of Non-Manufacturing Omitted Property Taxes ×Ã`òðõ@MÕK@ñð`ñð]@@@Ùöñô æ ¢ ¢ @Ä

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.

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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.

Page 85: Request for Sharing of Non-Manufacturing Omitted Property ... · Request for Sharing of Non-Manufacturing Omitted Property Taxes ×Ã`òðõ@MÕK@ñð`ñð]@@@Ùöñô æ ¢ ¢ @Ä

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.

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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

Page 87: Request for Sharing of Non-Manufacturing Omitted Property ... · Request for Sharing of Non-Manufacturing Omitted Property Taxes ×Ã`òðõ@MÕK@ñð`ñð]@@@Ùöñô æ ¢ ¢ @Ä

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.

Page 88: Request for Sharing of Non-Manufacturing Omitted Property ... · Request for Sharing of Non-Manufacturing Omitted Property Taxes ×Ã`òðõ@MÕK@ñð`ñð]@@@Ùöñô æ ¢ ¢ @Ä

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

Page 89: Request for Sharing of Non-Manufacturing Omitted Property ... · Request for Sharing of Non-Manufacturing Omitted Property Taxes ×Ã`òðõ@MÕK@ñð`ñð]@@@Ùöñô æ ¢ ¢ @Ä

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.

Page 90: Request for Sharing of Non-Manufacturing Omitted Property ... · Request for Sharing of Non-Manufacturing Omitted Property Taxes ×Ã`òðõ@MÕK@ñð`ñð]@@@Ùöñô æ ¢ ¢ @Ä

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.

Page 91: Request for Sharing of Non-Manufacturing Omitted Property ... · Request for Sharing of Non-Manufacturing Omitted Property Taxes ×Ã`òðõ@MÕK@ñð`ñð]@@@Ùöñô æ ¢ ¢ @Ä

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.

Page 92: Request for Sharing of Non-Manufacturing Omitted Property ... · Request for Sharing of Non-Manufacturing Omitted Property Taxes ×Ã`òðõ@MÕK@ñð`ñð]@@@Ùöñô æ ¢ ¢ @Ä

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

Page 93: Request for Sharing of Non-Manufacturing Omitted Property ... · Request for Sharing of Non-Manufacturing Omitted Property Taxes ×Ã`òðõ@MÕK@ñð`ñð]@@@Ùöñô æ ¢ ¢ @Ä

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.

Page 94: Request for Sharing of Non-Manufacturing Omitted Property ... · Request for Sharing of Non-Manufacturing Omitted Property Taxes ×Ã`òðõ@MÕK@ñð`ñð]@@@Ùöñô æ ¢ ¢ @Ä

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

Page 95: Request for Sharing of Non-Manufacturing Omitted Property ... · Request for Sharing of Non-Manufacturing Omitted Property Taxes ×Ã`òðõ@MÕK@ñð`ñð]@@@Ùöñô æ ¢ ¢ @Ä

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.

Page 96: Request for Sharing of Non-Manufacturing Omitted Property ... · Request for Sharing of Non-Manufacturing Omitted Property Taxes ×Ã`òðõ@MÕK@ñð`ñð]@@@Ùöñô æ ¢ ¢ @Ä

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

Page 97: Request for Sharing of Non-Manufacturing Omitted Property ... · Request for Sharing of Non-Manufacturing Omitted Property Taxes ×Ã`òðõ@MÕK@ñð`ñð]@@@Ùöñô æ ¢ ¢ @Ä

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.

Page 98: Request for Sharing of Non-Manufacturing Omitted Property ... · Request for Sharing of Non-Manufacturing Omitted Property Taxes ×Ã`òðõ@MÕK@ñð`ñð]@@@Ùöñô æ ¢ ¢ @Ä

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

Page 99: Request for Sharing of Non-Manufacturing Omitted Property ... · Request for Sharing of Non-Manufacturing Omitted Property Taxes ×Ã`òðõ@MÕK@ñð`ñð]@@@Ùöñô æ ¢ ¢ @Ä

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.

Page 100: Request for Sharing of Non-Manufacturing Omitted Property ... · Request for Sharing of Non-Manufacturing Omitted Property Taxes ×Ã`òðõ@MÕK@ñð`ñð]@@@Ùöñô æ ¢ ¢ @Ä

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

Page 101: Request for Sharing of Non-Manufacturing Omitted Property ... · Request for Sharing of Non-Manufacturing Omitted Property Taxes ×Ã`òðõ@MÕK@ñð`ñð]@@@Ùöñô æ ¢ ¢ @Ä

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.

Page 102: Request for Sharing of Non-Manufacturing Omitted Property ... · Request for Sharing of Non-Manufacturing Omitted Property Taxes ×Ã`òðõ@MÕK@ñð`ñð]@@@Ùöñô æ ¢ ¢ @Ä

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

Page 103: Request for Sharing of Non-Manufacturing Omitted Property ... · Request for Sharing of Non-Manufacturing Omitted Property Taxes ×Ã`òðõ@MÕK@ñð`ñð]@@@Ùöñô æ ¢ ¢ @Ä

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.

Page 104: Request for Sharing of Non-Manufacturing Omitted Property ... · Request for Sharing of Non-Manufacturing Omitted Property Taxes ×Ã`òðõ@MÕK@ñð`ñð]@@@Ùöñô æ ¢ ¢ @Ä

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

Page 105: Request for Sharing of Non-Manufacturing Omitted Property ... · Request for Sharing of Non-Manufacturing Omitted Property Taxes ×Ã`òðõ@MÕK@ñð`ñð]@@@Ùöñô æ ¢ ¢ @Ä

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.

Page 106: Request for Sharing of Non-Manufacturing Omitted Property ... · Request for Sharing of Non-Manufacturing Omitted Property Taxes ×Ã`òðõ@MÕK@ñð`ñð]@@@Ùöñô æ ¢ ¢ @Ä

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

Page 107: Request for Sharing of Non-Manufacturing Omitted Property ... · Request for Sharing of Non-Manufacturing Omitted Property Taxes ×Ã`òðõ@MÕK@ñð`ñð]@@@Ùöñô æ ¢ ¢ @Ä

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.

Page 108: Request for Sharing of Non-Manufacturing Omitted Property ... · Request for Sharing of Non-Manufacturing Omitted Property Taxes ×Ã`òðõ@MÕK@ñð`ñð]@@@Ùöñô æ ¢ ¢ @Ä

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

Page 109: Request for Sharing of Non-Manufacturing Omitted Property ... · Request for Sharing of Non-Manufacturing Omitted Property Taxes ×Ã`òðõ@MÕK@ñð`ñð]@@@Ùöñô æ ¢ ¢ @Ä

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

Page 110: Request for Sharing of Non-Manufacturing Omitted Property ... · Request for Sharing of Non-Manufacturing Omitted Property Taxes ×Ã`òðõ@MÕK@ñð`ñð]@@@Ùöñô æ ¢ ¢ @Ä

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.

Page 111: Request for Sharing of Non-Manufacturing Omitted Property ... · Request for Sharing of Non-Manufacturing Omitted Property Taxes ×Ã`òðõ@MÕK@ñð`ñð]@@@Ùöñô æ ¢ ¢ @Ä

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.

Page 112: Request for Sharing of Non-Manufacturing Omitted Property ... · Request for Sharing of Non-Manufacturing Omitted Property Taxes ×Ã`òðõ@MÕK@ñð`ñð]@@@Ùöñô æ ¢ ¢ @Ä

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.

Page 113: Request for Sharing of Non-Manufacturing Omitted Property ... · Request for Sharing of Non-Manufacturing Omitted Property Taxes ×Ã`òðõ@MÕK@ñð`ñð]@@@Ùöñô æ ¢ ¢ @Ä

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.

Page 114: Request for Sharing of Non-Manufacturing Omitted Property ... · Request for Sharing of Non-Manufacturing Omitted Property Taxes ×Ã`òðõ@MÕK@ñð`ñð]@@@Ùöñô æ ¢ ¢ @Ä

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.

Page 115: Request for Sharing of Non-Manufacturing Omitted Property ... · Request for Sharing of Non-Manufacturing Omitted Property Taxes ×Ã`òðõ@MÕK@ñð`ñð]@@@Ùöñô æ ¢ ¢ @Ä

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

Page 116: Request for Sharing of Non-Manufacturing Omitted Property ... · Request for Sharing of Non-Manufacturing Omitted Property Taxes ×Ã`òðõ@MÕK@ñð`ñð]@@@Ùöñô æ ¢ ¢ @Ä

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.

Page 117: Request for Sharing of Non-Manufacturing Omitted Property ... · Request for Sharing of Non-Manufacturing Omitted Property Taxes ×Ã`òðõ@MÕK@ñð`ñð]@@@Ùöñô æ ¢ ¢ @Ä

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.

Page 118: Request for Sharing of Non-Manufacturing Omitted Property ... · Request for Sharing of Non-Manufacturing Omitted Property Taxes ×Ã`òðõ@MÕK@ñð`ñð]@@@Ùöñô æ ¢ ¢ @Ä

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.

Page 119: Request for Sharing of Non-Manufacturing Omitted Property ... · Request for Sharing of Non-Manufacturing Omitted Property Taxes ×Ã`òðõ@MÕK@ñð`ñð]@@@Ùöñô æ ¢ ¢ @Ä

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.

Page 120: Request for Sharing of Non-Manufacturing Omitted Property ... · Request for Sharing of Non-Manufacturing Omitted Property Taxes ×Ã`òðõ@MÕK@ñð`ñð]@@@Ùöñô æ ¢ ¢ @Ä

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.

Page 121: Request for Sharing of Non-Manufacturing Omitted Property ... · Request for Sharing of Non-Manufacturing Omitted Property Taxes ×Ã`òðõ@MÕK@ñð`ñð]@@@Ùöñô æ ¢ ¢ @Ä

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.

Page 122: Request for Sharing of Non-Manufacturing Omitted Property ... · Request for Sharing of Non-Manufacturing Omitted Property Taxes ×Ã`òðõ@MÕK@ñð`ñð]@@@Ùöñô æ ¢ ¢ @Ä

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.

Page 123: Request for Sharing of Non-Manufacturing Omitted Property ... · Request for Sharing of Non-Manufacturing Omitted Property Taxes ×Ã`òðõ@MÕK@ñð`ñð]@@@Ùöñô æ ¢ ¢ @Ä

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

Page 124: Request for Sharing of Non-Manufacturing Omitted Property ... · Request for Sharing of Non-Manufacturing Omitted Property Taxes ×Ã`òðõ@MÕK@ñð`ñð]@@@Ùöñô æ ¢ ¢ @Ä

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.

Page 125: Request for Sharing of Non-Manufacturing Omitted Property ... · Request for Sharing of Non-Manufacturing Omitted Property Taxes ×Ã`òðõ@MÕK@ñð`ñð]@@@Ùöñô æ ¢ ¢ @Ä

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.

Page 126: Request for Sharing of Non-Manufacturing Omitted Property ... · Request for Sharing of Non-Manufacturing Omitted Property Taxes ×Ã`òðõ@MÕK@ñð`ñð]@@@Ùöñô æ ¢ ¢ @Ä

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

Page 127: Request for Sharing of Non-Manufacturing Omitted Property ... · Request for Sharing of Non-Manufacturing Omitted Property Taxes ×Ã`òðõ@MÕK@ñð`ñð]@@@Ùöñô æ ¢ ¢ @Ä

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.

Page 128: Request for Sharing of Non-Manufacturing Omitted Property ... · Request for Sharing of Non-Manufacturing Omitted Property Taxes ×Ã`òðõ@MÕK@ñð`ñð]@@@Ùöñô æ ¢ ¢ @Ä

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

Page 129: Request for Sharing of Non-Manufacturing Omitted Property ... · Request for Sharing of Non-Manufacturing Omitted Property Taxes ×Ã`òðõ@MÕK@ñð`ñð]@@@Ùöñô æ ¢ ¢ @Ä

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.

Page 130: Request for Sharing of Non-Manufacturing Omitted Property ... · Request for Sharing of Non-Manufacturing Omitted Property Taxes ×Ã`òðõ@MÕK@ñð`ñð]@@@Ùöñô æ ¢ ¢ @Ä

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

Page 131: Request for Sharing of Non-Manufacturing Omitted Property ... · Request for Sharing of Non-Manufacturing Omitted Property Taxes ×Ã`òðõ@MÕK@ñð`ñð]@@@Ùöñô æ ¢ ¢ @Ä

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.

Page 132: Request for Sharing of Non-Manufacturing Omitted Property ... · Request for Sharing of Non-Manufacturing Omitted Property Taxes ×Ã`òðõ@MÕK@ñð`ñð]@@@Ùöñô æ ¢ ¢ @Ä

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

Page 133: Request for Sharing of Non-Manufacturing Omitted Property ... · Request for Sharing of Non-Manufacturing Omitted Property Taxes ×Ã`òðõ@MÕK@ñð`ñð]@@@Ùöñô æ ¢ ¢ @Ä

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.

Page 134: Request for Sharing of Non-Manufacturing Omitted Property ... · Request for Sharing of Non-Manufacturing Omitted Property Taxes ×Ã`òðõ@MÕK@ñð`ñð]@@@Ùöñô æ ¢ ¢ @Ä

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

Page 135: Request for Sharing of Non-Manufacturing Omitted Property ... · Request for Sharing of Non-Manufacturing Omitted Property Taxes ×Ã`òðõ@MÕK@ñð`ñð]@@@Ùöñô æ ¢ ¢ @Ä

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.

Page 136: Request for Sharing of Non-Manufacturing Omitted Property ... · Request for Sharing of Non-Manufacturing Omitted Property Taxes ×Ã`òðõ@MÕK@ñð`ñð]@@@Ùöñô æ ¢ ¢ @Ä

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

Page 137: Request for Sharing of Non-Manufacturing Omitted Property ... · Request for Sharing of Non-Manufacturing Omitted Property Taxes ×Ã`òðõ@MÕK@ñð`ñð]@@@Ùöñô æ ¢ ¢ @Ä

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.

Page 138: Request for Sharing of Non-Manufacturing Omitted Property ... · Request for Sharing of Non-Manufacturing Omitted Property Taxes ×Ã`òðõ@MÕK@ñð`ñð]@@@Ùöñô æ ¢ ¢ @Ä

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

Page 139: Request for Sharing of Non-Manufacturing Omitted Property ... · Request for Sharing of Non-Manufacturing Omitted Property Taxes ×Ã`òðõ@MÕK@ñð`ñð]@@@Ùöñô æ ¢ ¢ @Ä

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.

Page 140: Request for Sharing of Non-Manufacturing Omitted Property ... · Request for Sharing of Non-Manufacturing Omitted Property Taxes ×Ã`òðõ@MÕK@ñð`ñð]@@@Ùöñô æ ¢ ¢ @Ä

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

Page 141: Request for Sharing of Non-Manufacturing Omitted Property ... · Request for Sharing of Non-Manufacturing Omitted Property Taxes ×Ã`òðõ@MÕK@ñð`ñð]@@@Ùöñô æ ¢ ¢ @Ä

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.

Page 142: Request for Sharing of Non-Manufacturing Omitted Property ... · Request for Sharing of Non-Manufacturing Omitted Property Taxes ×Ã`òðõ@MÕK@ñð`ñð]@@@Ùöñô æ ¢ ¢ @Ä

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