MAIL TO:
Wisconsin Department of Revenue
APPEAL WITHDRAWAL
State Board of Assessors
2135 Rimrock Rd, Mail Drop 6-97
PO Box 8971
Madison WI 53708-8971
Appeal Number:
Assessment Year:
State Identification Number:
__ __ - __ __ - ____ ____ ____ - R or P
__ __ __ __ __ __ __ __ __
* AA
* CO
Taxation District
DOR Parcel or Account Number
* “County of” on assessment notice is “AA” and “CO” (e.g. 76-13)
Name of Property Owner:
Street Address of Property:
Mailing Address:
Taxation District (Municipality):
City, State &
County:
Zip Code:
Telephone Number:
Fax Number:
REAL ESTATE/PERSONAL PROPERTY ASSESSMENT & FILING PENALTY, AND EXEMPT COMPUTERS
The Undersigned Certifies:
I, having filed an objection against the 20____ assessment of the above property, requesting the assessment be reviewed
pursuant to sec. 70.995(8)(c), Wis. Stats., do hereby withdraw my appeal (for this year only) and certify that the assessed
valuation as determined here below shall be sustained. I understand that the filing fee is non-refundable.
Assessed Value
___ REAL ESTATE
Land
$ _________________________________
ASSESSMENT
Improvements
_________________________________
___ REAL ESTATE
FILING PENALTY
TOTAL
$ _________________________________
Assessed Value
___ PERSONAL PROPERTY
Boats & Watercraft
$ ________________________________
ASSESSMENT
Machinery & Equipment
________________________________
___ PERSONAL PROPERTY
FILING PENALTY
Furniture & Fixtures
________________________________
All Other Personal Property
________________________________
Buildings on Leased Land
________________________________
Mobile Homes
________________________________
TOTAL
$ ________________________________
Assessed Value
___ EXEMPT COMPUTERS
TOTAL
$ ________________________________
___ CLASSIFICATION
The Undersigned Certifies:
I, having filed an objection against the 20____ classification of the above property/business for property tax assessment
purposes, requesting the classification be reviewed pursuant to sec. 70.995(8)(c), Wis. Stats., do hereby withdraw my appeal (for
this year only) and certify that the classification as determined by the Department of Revenue be sustained. I understand that the
filing fee is non-refundable.
Owner’s Signature:
Telephone #:
Date:
Authorized Agent’s
Telephone #:
Date:
Signature:
PA-138 (R. 05-11)
Wisconsin Department of Revenue