Form Pe-615a - Statement Of Assessment
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TOWN
STATEMENT OF ASSESSMENT – YEAR 20
VILLAGE
of
CITY
SEE INSTRUCTIONS ON REVERSE SIDE
COUNTY of
TID No.
or ER TID No.
When completing this document do not write over shaded areas.
PARCEL COUNT
# of Acres
Value of
Value of
Total
Improve-
Land
Only
Land
Improvements
Value of Land
Line
ments
Whole No
and Improvements
No.
(Col. A)
(Col. B)
(Col. C)
(Col. D)
(Col. E)
(Col. F)
1
Residential – Class 1
0
2
Commercial – Class 2
0
4
Agricultural – Class 4
0
5
Undeveloped – Class 5
0
5m Agricultural Forest – Class 5m
0
6
Forest – Class 6
0
7
Other – Class 7
0
8
TOTAL ALL COLUMNS
0
0
0
0
0
0
9
Number of Personal Owners in Roll
10
Boats and Other Watercraft Not Exempt
NOTE: If lines 10
11
Machinery, Tools and Patterns
through 13 contain
any values, please
12
Furniture, Fixtures and Equipment
fill in line 9.
13
All Other Personal Property Not Exempt
TOTAL OF PERSONAL PROPERTY, Total of Lines 10 Through 13
14
0
15 AGGREGATE ASSESSED VALUE OF ALL PROPERTY ON THIS ROLL SUBJECT TO THE GENERAL PROPERTY
0
TAX (Total of Lines 8 & 14). Must Agree With Total Value of School District(s) Listed Below
Assessed Value of
School
School Districts in TID
District
Assessed Value of
Codes
Complete School District Section
General Property
(Real Estate &
Personal Property)
SCHOOL DISTRICT NAMES
Subject to the
General Property Tax
(Col. A)
(Col. C)
(Col. B)
2 0
21
22
23
24
25
26
27
TOTAL COL. C (Col. C must equal line 15 above.)
Total of Column C must equal line 15 above.
0
SEPARATE UNION HIGH SCHOOL DISTRICTS (In addition to and independent of school districts entered above.)
28
29
VOCATIONAL AND TECHNICAL SCHOOL DISTRICTS (In addition to and independent of school districts entered above.)
3 0
31
32
PE-615A (R. 7-08)
Wisconsin Department of Revenue
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