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eRETR Public View—Receipt Page 1 of 1 <br /> ELECTRONIC REAL ESTATE TRANSFER RECEIPT <br /> WISCONSIN DEPARTMENT OF REVENUE 3 LDY2 <br /> INSTRUCTIONS <br /> 1 Grantors and grantees must review this receipt, noting grantor and <br /> grantee responsibilities. <br /> Mail or deliver the following items to: <br /> Dane County Register of Deeds,210 MARTIN LUTHER KING JR BLVD,PO <br /> 2 BOX 1438, MADISON, WI 53 701-1 438 <br /> • This receipt page,along with a transfer fee of$300.00. <br /> • The deed or instrument of conveyance,along with a recording fee of <br /> $30.00 regardless of the number of pages. <br /> To view the details of the real estate transfer return online, go to <br /> https://ww2.revenue.wi.gov/RETRWebPublic/application.You will need to know the receipt number,the <br /> total value of the real estate transferred,and the last name of one grantor or grantee. <br /> Receipt 3LDY2. Filed May 14,2015,2:26 PM -Dane County.Conveyance date 2015-05-20. <br /> Value transferred $100,000 Transfer fee $300.00 <br /> Value subject to fee $100,000 Fee exemption number <br /> Grantors ZIEGLER,BARBARA A. <br /> Grantees HEBERT,MICHELLE <br /> Tax bill address MICHELLE HEBERT,1625 WALDOFR BLVD.,MADISON,Wisconsin 53719 <br /> Property Location 6936 MIDTOWN ROAD(Town of Middleton) <br /> Parcels 038/070834493602 <br /> Lot One(1)of Certified Survey Map No.2086 recorded in the Dane County <br /> Legal description Register of Deeds Office In Volume 8 of Certified Survey Maps,page 282,as <br /> Document No. 1477853,in the Town of Middleton,Dane County,Wisconsin. <br /> Grantor responsibilities: Grantors are responsible for paying the proper fee amount—verify the total <br /> property value,fee amount and fee exemption before sending this receipt to the county Register of <br /> Deeds.' <br /> Grantee responsibilities:Grantees assert that this property is not a primary residence2, and that the <br /> property is not subject to weatherization standards with exdusion code"W-11".3 <br /> Preparer DANE COUNTY TITLE COMPANY,608-271-2800, <br /> LVAN DEG RIFF 0 DAN ECOU NTYTITLE.CO M <br /> Grantor agent <br /> Grantee agent <br /> If you have any questions about the Real Estate Transfer Return visit the Real Estate Transfer Web site at <br /> htt p://www.dor.state.wl.us/ust/retn.html.You can also contact your County Register of Deeds(see http://www.wrdaonline.org/). <br /> Information on the real estate transfer return is used to administer Wisconsin's laws of income tax,real estate transfers,rental unit energy <br /> efficiency,lottery tax credit and general property tax.The transfer of Wisconsin real estate In a taxable transaction must be reported on your <br /> Wisconsin Income tax return.This is true whether you were a resident,a part-year resident,or a nonresident of Wisconsin.If you are a <br /> nonresident of Wisconsin,you must file Form 1NPR to report the sale. <br /> 1 Penalties for use of an improper exemption are imposed per s.77.26(8),Stats.Penalties for falsifying the property value are Imposed per s. <br /> 77.27,Stats. <br /> 2 Penalties for improperly claiming the Lottery&Gaming Credit as Primary Residence are imposed per Chapter Tax 20.19. <br /> 3 Penalties relating to Weatherimtron claims are imposed per s.101.122.Stats. <br /> • For more information see Chapter CDMM67,s.67.03 and 67.04. <br /> https://ww2.revenue.wi.gov/RETRWebPubliC/fastpathreceipt?a=19WJvVMVhywCDIFCp... 5/14/2015 <br />