Form 3674 - Application For Obsolete Property Rehabilitation Exemption Certificate - 2003

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Clear Form

Michigan Department of Treasury

3674 (5-03)

Application for Obsolete Property Rehabilitation Exemption Certificate

This form is issued as provided by P.A. 146 of 2000. Filing of this form is voluntary. This application should be filed after the district is established. This project will not receive

tax benefits until approved by the State Tax Commission. Applications received after October 31 may not be acted upon in the current year. This application is subject to audit by

the State Tax Commission.

INSTRUCTIONS: File the original and one copy of this form and the required attachments with the clerk of the local government unit. (The State Tax Commission requires one

copy of the Application and the Resolution. The original is retained by the clerk.) Please see State Tax Commission Bulletin 9 of 2000 for more information about the Obsolete

Property Rehabilitation Exemption. The following must be provided to the local government unit as attachments to this application: (a) General description of the obsolete facility;

(b)General description of the proposed use of the rehabilitated facility, (c) Description of the general nature and extent of the rehabilitation to be undertaken, (d) A descriptive list

of the fixed building equipment that will be a part of the rehabilitated facility, (e) A time schedule for undertaking and completing the rehabilitation of the facility, (f) A statement of

the economic advantages expected from the exemption.

Applicant (Company) Name (applicant must be the OWNER of the facility)

Company Mailing address (No. and street, P.O. Box, City, State, Zip code)

Location of obsolete facility (No. and street, P.O. Box, City, State, Zip Code)

City, Township, Village

County

Date of Commencement of Rehabilitation

Planned date of Completion of Rehabilitation

School District where facility is located

(include school code)

Estimated Cost of Rehabilitation

Number of years exemption requested

Expected project likelihood (check all that apply):

Increase Commercial activity

Legal description of Obsolete Property

Create employment

Retain employment

Prevent a loss of employment

Revitalize urban areas

Increase number of residents in the

community in which the facility is situated

Indicate the number of jobs to be retained or

created as a result of rehabilitating the facility,

including expected construction employment _____

The State Treasurer may exclude from the specific tax up to 1/2 of the mills levied for local school operating purposes and for the State Education Tax. Check the following box

if you wish to be considered for this exclusion.

APPLICANT'S CERTIFICATION

The undersigned, authorized officer of the company making this application certifies that, to the best of his/her knowledge, no information contained

herein or in the attachments hereto is false in any way and that all of the information is truly descriptive of the property for which this application is being

submitted. Further, the undersigned is aware that, if any statement or information provided is untrue, the exemption provided by P.A. 146 of 2000 may

be in jeopardy.

The applicant certifies that this application relates to a rehabilitation program that, when completed, constitutes a rehabilitated facility, as

defined by P.A. 146 of 2000 and that the rehabilitation of the facility would not be undertaken without the applicant's receipt of the exemption

certificate.

It is further certified that the undersigned is familiar with the provisions of P.A. 146 of 2000, of the Michigan Compiled Laws; and to the best of his/her

knowledge and belief, (s)he has complied or will be able to comply with all of the requirements thereof which are prerequisite to the approval of the

application by the local unit of government and the issuance of an Obsolete Property Rehabilitation Exemption Certificate by the State Tax Commission.

Contact person name

Title

Telephone Number

Mailing Address

Company Officer name

Title

Telephone Number

Signature

Telephone Number

LOCAL GOVERNMENT UNIT CLERK CERTIFICATION

Clerk must also complete Parts 1-3 on Page 2.

Signature