STATE OF WISCONSIN
Town of ________
________ County
We, the undersigned, disinterested freeholders of the town, having been appointed by ________ ________, chairperson of the Town of ________, ________ County, Wisconsin, on ________ ___, 20__, to appraise the damages done upon the premises of ________ ________, in the Town of ________, by ________ [describe number and type of animal] belonging to ________ ________ that were distrained by ________ ________ on ________ ___, 20__, the premises being described as follows: [describe land as in notice], certify that upon appointment we repaired to the above-described premises and viewed the damages done, and, [if applicable having taken the evidence of witnesses of the facts and circumstances necessary to enable us to ascertain and fix the extent of damages,] [we certify that the amount of damages, fixed by us, is $________; and that the cost of keeping the animals from the time the animals were distrained to the present is $________; and our fees for services in this action are $________ (or, if a dispute shall arise) and a dispute having arisen between ________ ________ and ________ ________, the owner of the animals, touching the extent of damages, and the sufficiency of the fence around the premises where the damage was done, having taken the evidence of witnesses of the facts and circumstances necessary to enable us to ascertain and fix the extent of damages and the sufficiency of the fence in question, we certify that the amount of the damages, as ascertained and fixed by us, is $________; that the cost of keeping the animals from the time the animals were distrained to the present, is $________; that our fees for services in this action are $________; and we determine that the fence around the premises, at the time the damage was done, was (sufficient or insufficient)].
Dated this ______ day of ________, 20__.
[Signatures of 3 appraisers]
