Multi-Parcel Tax Exemption Report Form

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MULTI-PARCEL TAX EXEMPTION REPORT FOR
THIS FORM MUST BE FILED WITH THE MUNICIPAL
CLERK NO LATER THAN MARCH 31, in even
(Enter Year)
numbered years (sec. 70.337, Wis. Stats.)
Tab throughout document or click with mouse as needed.
(See instructions on reverse side)
1. Name of Organization
2. Purpose of Organization
4. Check appropriate box and enter the name of the taxation district and county in which the
3. Address of Organization
exempt property is located:
Town
Village
of:
County
,
City
11. Property Used in a
5. Property Address
6. Parcel Number or
7. Date
8. Parcel Use
9. Estimated
10. Was Property
Trade/Business Where
Legal Description
Acquired
(See instructions)
Fair Market Value
Leased in Last
Owner was Subject to
(mm/dd/ccyy)
Category
2 Years?
Unrelated Business Income
(See instructions)
(See instructions)
Under sec. 511-515
of IRC in Last 2 Years?
Yes
Yes
No
No
Yes
Yes
No
No
Yes
Yes
No
No
Yes
Yes
No
No
Yes
Yes
No
No
Yes
Yes
No
No
Yes
Yes
No
No
13. Signature
14. Telephone
12. Name and Title
–
(
)
15. Street Address
State
Zip
16. Date
PC-220A (R. 6-09)
Wisconsin Department of Revenue

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