STATE OF WISCONSIN
Town of ________
________ County
The undersigned, Town Board of the Town of ________, ________ County, Wisconsin, respectfully submit the following statement, stating in detail items including the previous year's revenues, expenditures, claims against the town allowed and disallowed, and current indebtedness of the town, during the year ending on ________ ___, 20__:
We hereby certify the above statement to be correct.
Dated this ______ day of ________, 20__.
[Signatures of town board]
