Form Pc-220 - Tax Exemption Report Form - Wisconsin
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Tax Exemption Report For
THIS FORM MUST BE FILED WITH THE LOCAL CLERK NO LATER
THAN MARCH 31 in even numbered years (sec. 70.337, Wis. Stats.)
(Year)
(See instructions on Reverse Side)
To instructions
1. Name of Organization
2. Address of Organization
3. Purpose of Organization
4. Location of Property
Town
Village
City of
,
County
5. Street Address of Property
6. Date Acquired
(mm‑dd‑yyyy)
7. Number of Acres
8. Parcel Number
9. Legal Description
Purpose of Property Check the box that best describes the property.
Estimated Fair Market Value of Parcel Check box that best
10.
11.
See instructions if parcel has more than one building put to different uses.
approximates the value of all improvements and land of property
described in Question 10.
Exemption Under Wis. Stat.
Church/Religious
1. $1.00 - $10,000
8. $5,000,001 - $10,000,000
Place of Worship . . . . . . . . . . . . . . . . . . . . . . . . . . s. 70.11(4)
2. $10,001 - $100,000
9. $10,000,001 - $15,000,000
Other ____________________________________ s. 70.11(
)
(Explain)
3. $100,001 - $200,000
10. $15,000,001 - $25,000,000
Educational (Incl. religious)
4. $200,001 - $500,000
11. $25,000,001 - $50,000,000
Grades K-12 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . s. 70.11(4)
Private College . . . . . . . . . . . . . . . . . . . . . . . . . . . . s. 70.11(3)
5. $500,001 - $1,000,000
12. $50,000,001 - $75,000,000
Other ____________________________________ s. 70.11(
)
(Explain)
6. $1,000,001 - $2,000,000
13. $75,000,001 - $100,000,000
Medical Facility
7. $2,000,001 - $5,000,000
14. OVER $100 million
Non-Profit Hospital (Incl. religious) . . . . . . . . . . . . s. 70.11(4m)
Medical Research Foundation . . . . . . . . . . . . . . . . s. 70.11(25)
12. Leasing of Property Was any portion of this property leased during
Other ____________________________________ s. 70.11(
)
the preceding two years?
(Explain)
No
Yes
Housing
If yes, describe portion leased, percentage of property, lessee, and
Nursing Home (Incl. religious) . . . . . . . . . . . . . . . . ss. 70.11
(4), (19)
how lease payment was used.
Retirement Home (Incl. religious) . . . . . . . . . . . . . ss. 70.11
(3a), (4)
Other ____________________________________ ss. 70.11
(3a), (18), (19), (
)
(Explain)
Public Benefit
YMCA/YWCA, Scouts, Boys' Club, Youth Hockey,
ss. 70.11(10), (12), (32)
Lions Camp, Bible Camp, Camp for Handicapped,
ss. 70.11(10m), (11), (22)
Women's Club, Historical Society, Library Assoc.,
ss. 70.11(4), (31m)
Fraternal, Labor/Farmers' Temple, Agri Fair,
ss. 70.11(4), (5), (16), (17)
Nonprofit Radio, Theatre, Art Gallery,
ss. 70.11(14), (29), (29m)
13. Unrelated Trade or Business
Sports and Entertainment Facility/Stadium,
ss. 70.11(31)(36)
Was this property used in an unrelated trade or business for which the
Humane Society,
ss. 70.11(28)
owner was subject to taxation under section 511 to 515 of the Internal
Historical Site, Public Trust
ss. 70.11(9), (20), (34), (35)
Revenue Code?
Other ______________________________________ ss. 70.11(
)
(Explain)
Yes
No
14. Name and Title
15. Signature
16. Telephone
(
)
–
17. Street Address
City
State
Zip
18. Date
(mm‑dd‑yyyy)
PC-220 (R. 12-15)
Wisconsin Department of Revenue
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