2011 LOTTERY AND GAMING CREDIT APPLICATION

You may claim the lottery and gaming credit for 2011 taxes, payable in 2012, if, on January 1, 2011, you were the owner of the property described in the box below and used that property as your primary residence. (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.) If the property below qualified as your primary residence on January 1, 2011, please complete and submit this form to the Manitowoc County Treasurer’s Office so the Credit will appear on your 2011 property tax bill. YOU MAY RETURN ONLY ONE CLAIM FORM.

The law requires that you notify your County Treasurer within 30 days after you no longer qualify to claim the credit, either because you no longer own the property or no longer use it as your primary residence.

For additional information about the Lottery and Gaming Credit, contact the Manitowoc County Treasurer’s Office at 920-683-4020 or 920-683-4021.

2011 LOTTERY AND GAMING CREDIT CLAIM

Property Address: Parcel Number:

________________________________ ________________________________

________________________________

________________________________

I attest, under penalty of law, that as of January 1, 2011, I was an owner of the property described above and that as of that date I used the property as my primary residence. I understand that I am to notify the County Treasurer within 30 days of the date on which I no longer own the property or no longer use the property as my primary residence.

Signature___________________________________________________ Date_____________________________

Telephone Number___________________________________________

Print Name Clearly___________________________________________

PLEASE RETURN THIS FORM TO THE MANITOWOC COUNTY TREASURER

1010 S. 8^th Street, Manitowoc WI 54220 treasurer@co.manitowoc.wi.us

Fax: 920-683-5180