Form Pc-201 - Inquiry Related To Rescinded Or Refunded Taxes
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INQUIRY RELATED TO RESCINDED OR REFUNDED TAXES
Wisconsin Department of Revenue
Local Government Services Section, 6‑97
(Section 74.41, Wis. Stats.)
PO Box 8971
Tab throughout document or click with mouse as needed.
Madison WI 53708‑8971
Submit a separate form for each inquiry for equalized value adjustment
or chargeback to Dept. of Revenue.
DOR USE ONLY
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?
YES
NO
2
Name of Owner and Legal Description
(If space is insufficient, attach additional sheets. Please type or print clearly.)
3
1
2
3
4
5
6
Enter the class of
4
RE
PP Code
RE
PP Code
property on the blank line
Land / Item
Imps
Land / Item
Imps
TOTAL
a. Assessed value before adj.
+
+
+
=
0
b. Assess value after adj. . . .
+
+
+
=
0
c. Amount of adj. . . . . . . . . . .
+
+
+
=
0
PLEASE ATTACH A COPY OF THE ORIGINAL TAX BILL
Net Taxes Rescinded or Refunded to be Charged Back to Taxing Jurisdictions – EXCLUDING INTEREST
5
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.
0 0
0 0
Technical College Dist.
h.
Total Net Tax Rescinded or Refunded – EXCLUDING INTEREST
Please explain why taxes were rescinded or refunded. Be specific and include the section of Wis. Stats. under which it was done.
6
(If space is insufficient, attach additional sheets. Please type or print clearly.)
Statute No(s).
Signature of Preparer
Date
Daytime Telephone Number
(mm/dd/ccyy)
7
(
)
–
FOR DEPARTMENT OF REVENUE USE ONLY
8
Qualify for equalization test?
NO
If NO, notify tax district clerk that no action will be taken.
YES
If YES, continue.
NO
If NO, notify tax district clerk that no action will be taken.
Would the
equalized
9
value have been different?
YES
If YES, we will:
EITHER
Adjust the
equalized value by $
and the
equalized value by $
Allow the chargeback of the rescinded or refunded taxes to the taxing
OR
jurisdictions.
10
Certify results and issue instructions to the clerks of the tax district and the taxing jurisdictions.
PC‑201 (R. 3‑09)
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