Wisconsin Direct Deposit Form 2 - Free Download | Page 2
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1. Section I – Identify taxation district/county submitting this form. Include 2-digit county code and 3-digit
municipal code. For counties, your municipal code is 999. Also include your 4-digit IPAS account
number, if known.
2. Section II – Choose either option “A” or “B.”
Complete left-hand column of form to identify current or first request information.
Complete right-hand column to show new/revised information.
2a. If option “A” is chosen: Take this form to your bank and secure a signature from a bank official
verifying accuracy of the town, village, city, or county’s account number.
2b. If option “B” is chosen: Send completed form directly to the Department of Revenue and we
will obtain account verification from the State Treasurer. You must be a member of the Local
Government Pooled Investment Fund before selecting Option B. Contact the Office of the State
Treasurer for details.
3. Section III – Sign and date the form. Enter contact person and telephone number.
4. If selecting a checking account as the deposit account, please void and attach a blank check for the
applicable account.
5. If you have questions regarding this form contact us at (608) 261-5374 or (608) 264-6892.
Mail completed form to: Bureau of Local Government Services, 6-97
Wisconsin Department of Revenue
PO Box 8971
Madison WI 53708-8971
Fax: (608) 264-6887
INSTRUCTIONS
