STATE OF WISCONSIN
Town of ________
________ County
To the State of Wisconsin, Department of Revenue:
The undersigned, clerk of the Town of ________, ________ County, Wisconsin, [name of municipality from which territory was transferred] certifies the latest assessed value of the real and personal property located within territory transferred from the Town of ________, [name of municipality from which territory was transferred] to [name of municipality to which territory was transferred] described in the attached certificate of the clerk of [name of municipality to which territory was transferred] dated ________ ___, 20__:
Dated this ______ day of ________, 20__.
[Signature of clerk of town from which territory was transferred]
Note: The same certification must be made to the clerk of the school district in which the transferred territory is located. If the transfer of territory from one municipality to another results from the incorporation of a new city or village, see
s. 66.0235 (2) (b), Wis. stats., for a computation based on the town's assessment rolls for the preceding 5 calendar years.
