Form M-R - Wisconsin Manufacturing Real Estate Return - 2013 Page 5
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125
Page
WISCONSIN
Form
2013
MANUFACTURING REAL ESTATE RETURN
M-R
ASSESSMENT DATE JANUARY 1, 2013
Name
PLEASE SEE
INSTRUCTIONS
DUE DATE
Street
PO Box
and follow
sequence of
March 1, 2013
City
State
Zip
completion on
pages 3 and 4.
State Identification Number (AA‑County‑Municipality‑R‑Parcel Number)
FOR DEPARTMENT USE ONLY
Check if
PENALTY
Stamp
name or
R
address has
10 days or less
31+ days
Local Parcel Number
changed
11-30 days
Cancel
Extension:
Date of Mailing
THIS PROPERTY IS LOCATED IN THE
Town
Village
City
Type
Initial
Date
Municipality:
Log In
Preaudit
County:
Audit
Street Address:
Review
(R. 1-13)
1. Is this property VACATED/ NON-OPERATING?
Yes
No
If vacant, what percent is vacant?
%
(Circle most appropriate description.)
2. During the last two years, did you (BUY), (SELL), or (LIST/OFFER FOR SALE) - this property?
Yes
No
If Yes, circle one of the above and give the date and price.
Date
$
3. Has there been an appraisal made on this property for any purpose since January 1, 2012?
Yes
No
If Yes, give the date and value; please attach a complete copy.
Date
$
4. Is any portion(s) of this real estate (land, land improvements, or structures) used for
waste treatment of air or water pollution? If yes, see page 12, schedule R-6.
Yes
No
SCHEDULE B – SUMMARY OF ALL REAL ESTATE CHANGES AS OF JANUARY 1, 2013
CHECK THIS BOX IF ABSOLUTELY NO REAL ESTATE CHANGES TO THIS PARCEL HAVE
}
NO CHANGES
OCCURRED SINCE JANUARY 1, 2012 (SCHEDULE Y-R MUST STILL BE COMPLETED)
CHANGES
– COMPLETE PROPER SCHEDULES
DECLARED VALUE
LEAVE BLANK
1. New Construction and Construction in Progress
(from Schedule R-1)
$
2. Remodeling and Construction in Progress
(from Schedule R-2)
$
3. Demolitions and Demolition in Progress
(from Schedule R-3)
$
4. Land Improvements and Construction in Progress
(from Schedule R-4)
$
I, the undersigned, declare under penalties of law that I have personally examined this return and completed schedules. To the best of my
knowledge and belief it is true, correct and complete. NOTE: Original signature is required.
Please Print Name
Email
EXT.#
Signature
Telephone Number
PREPARER
SIGN
(
)
–
Mail this
HERE
Firm or Title
Fax Number
completed
Date
return to the
(
)
–
appropriate
Please Print Name
Email
District Office
listed on
MANUF/
EXT.#
page 2.
OWNER
Signature
Telephone Number
SIGN
(
)
–
HERE
Firm or Title
Fax Number
Date
(
)
–
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