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CITY OF MIDDLETON CERTIFICATION OF SPECIAL ASSESSMENT Please enclose check to the City of Middleton for $40.00 Mail form & check to City of Middleton, 7426 Hubbard Avenue, Middleton WI 53562 Property Address: Parcel Number: Owner's Name: Buyer's Name: Legal Description: Public Improvements Planned? YES NO If yes, what year? Public Improvements Commenced? YES NO If yes, what year? Current Special Assessments on tax roll or invoiced: YES NO If yes: Delinquent Utility: YES NO Amount due including late charges * A final water read is required for a closing Assessment & Taxes: 2014 Mill Rate $22.05 Signature Mail Completed Form to: TITLE COMPANY ADDRESS CITY, STATE ZIP Revised 4/10/2015 I, DO HEREBY CERTIFY, that as of day of the information provided, represents to the best of my knowledge, special assessments, assessments, taxes, and utiliity charges subject to the above property. I work for the the City of Middleton, in the County of Dane, Wisconsin, and have access to the records in connection with special assessments, assessments, taxes, and utiliity charges for all premises situated in the City of Middleton, CONTACT & PHONE Per Wis. §66.0907(3)(f) if the sidewalk expense is not paid prior to the tax roll being prepared, the expense is entered onto the tax roll as a special tax against the land. The date the property owner is billed is the time the cost is known. Estimates will not be given as they are not required by statue or ordinance. Please refer to Access Dane http://accessdane.co.dane.wi.us