Form Pc-201 - Request For Charge Back Of Rescinded Or Refunded Taxes
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Request for Charge Back of Rescinded or Refunded Taxes
(Section 74.41, Wis. Stats.)
DOR USE ONLY
Tab throughout document or click with mouse as needed.
Please read the instructions on the reverse side before completing this form.
CASE NO.
Assessment Year
County
Co Mun Code
Town
Village
City
of
1
Real Estate Parcel No.
Personal Property Account No.
Is this parcel in a TID?
NO
YES: TID #
2
Name of Property Owner
Personal Property Category
(see instructions)
3
(g)
Real Estate
Assessment BEFORE Adjustment
Assessment AFTER Adjustment
4
Total Assessment
(a)
(b)
(c)
(d)
(e)
(f )
Difference
Class
Land
Improvement
Total
Land
Improvement
Total
(c - f)
(a + b)
(d + e)
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Totals
0
0
0
0
0
0
0
BEFORE Adjustment
AFTER Adjustment
Difference
5
Personal Property . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
0
Non-Manufacturing
Manufacturing
(a)
(b) = (a) x .80
(c) = (a) x .20
6
Total manufacturing interest refund/rescinded
0.00
0.00
Net Taxes Rescinded or Refunded to be Charged Back to Taxing Jurisdictions – EXCLUDING INTEREST
7
Code
Name of Taxing Jurisdictions
Net Tax
a.
State of Wisconsin
b.
County
–
c.1
Special Dist.
–
c.2
Special Dist.
d.
Local
–
e.
School Dist.
–
f.
Union High School Dist.
g.
Technical College Dist.
0 0
0 0
h.
Total Net Tax Rescinded or Refunded – EXCLUDING INTEREST
Please explain why taxes were rescinded or refunded. Be specific and include the section of Wisconsin Statutes under which it
8
was done.
(If space is insufficient, attach additional sheets. Please type or print clearly.)
Statute No(s).
I hereby certify to the best of my knowledge and belief this form is complete and correct and, in the case of refunded tax, the tax has
been refunded to the property owner.
Preparer's Name
Email Address
9
Signature of Preparer
Date
Daytime Telephone Number
(mm/dd/ccyy)
–
(
)
/
/
PC-201 (R. 2-10)
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