LATE LOTTERY & GAMING CREDIT CLAIM FORM

This form is being used by a taxpayer to:

[ ] Remove a credit from a Real Estate or Personal Property Tax Bill. No credit should have appeared on the tax bill according to the taxpayer.

I attest, under penalty of law that as of __________________ (Date), I no longer used Parcel #________________________ as my primary residence.

[ ] Make Late Claim for a Real Estate or Personal Property Lottery & Gaming Credit. No credit appears on the property tax bill and they indicate they are entitled to get a lottery & gaming credit.

I attest, under penalty of law, that as of January 1,_____(Year), I was the owner of Parcel #________________________ and as of that date I used it as my primary residence.

[ ] Make Late Claim for a Real Estate or Personal Property Lottery & Gaming Credit on property which was purchased after January 1^st and was used by the previous owner as a primary residence on January 1^st.

DO NOT CLAIM THE CREDIT IF:

A. The home was not the primary residence of the previous owner on January 1^st.

B. The home was used as rental property on January 1^st.

I attest, under penalty of law, that as of _________________(insert date you acquired this property),

I am the owner of Parcel #__________________________and I am using it as my primary residence.

If known, provide the following information:

Seller’s Name___________________________________________ TAX YEAR FOR WHICH YOU ARE CLAIMING THE CREDIT

Seller’s Address_________________________________________ 20_____

Owners Name & Mailing Address Parcel Number: _______________________________________

_____________________ Town, Village, City of:__________________________________

_____________________ County of:____________________________________________

_____________________ School District_______________________

I understand that by signing this application, I am changing a claim for the lottery & gaming credit, for the year __________, and future years. I understand that I am to notify the Manitowoc County Treasurer within 30 days of the date on which I no longer use the property as my primary residence.

Lottery Credit Amount $_____________ Parcel #______________________________

Signature______________________________________ Bill #_________________________

Telephone Number______________________________ Tax Receipt #_________________

Print Name Clearly______________________________ Date_________________________

Note: Your primary residence is where you live most of the time. When you are temporarily away, it is the home to which you intend to return. You can have only one primary residence.

YOU CAN HAVE ONLY ONE PARCEL WITH A LOTTERY & GAMING CREDIT CLAIM.

This form needs to be returned to the Local Treasurer by January 31^st to receive the credit on the current bill.

To file a claim after January 31^st a copy of this form needs to be sent to the Manitowoc County Treasurer, 1010 S 8^th Street, Manitowoc WI 54220. Phone (920)683-4020 Fax (920)683-5180 or e-mail:treasurer@co.manitowoc.wi.us

AND

A copy of this form and a copy of your tax bill must be submitted prior to October 1st, to the Wisconsin Department of Revenue, PO Box 8971, Madison, WI 53708-8971. Phone (608)266-9457 or (608)266-0772. A refund check will then be issued to you by the State of Wisconsin.

1^st White Copy: to Taxpayer-Submit to State of Wisconsin, 2^nd White Copy: to County Treasurer,

Yellow Copy: to Local Treasurer, Pink Copy: to Taxpayer