Form 4230 Affidavit Filed By An Innovations Center For Claiming Property Tax Exemption

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Michigan Department of Treasury
4230 (11-04)
Affidavit Filed by an Innovations Center for Claiming Property Tax Exemption
Issued under P.A. 244 and 245 of 2004. Filing is voluntary.
INSTRUCTIONS: Read instructions on Page 2 of this form before completing this application. File this form and the
required attachments with the assessor of the local tax collecting unit.
PART 1: TO BE COMPLETED BY THE APPLICANT
1. Applicant/Company Name (Applicant must be an Innovations Center)
2. County
Company Mailing Address (No. and Street, P.O. Box, City, State, ZIP Code)
3. City/Township/Village (Circle one and provide its name)
Location of Innovations Center (No. and Street, City, State, ZIP Code)
4. Local School District
5. Exemption is being claimed for:
Real Property
Personal Property
If you checked Real Property, attach the legal description.
5a. If you checked Personal Property, check one or both of the boxes below:
This request is for all personal property owned or used by the Administration of an Innovations Center.
This request is for all personal property owned or used by any Qualified High-Technology Business. Note: If you checked this box, attach a
list of the name(s) and address(es) of the Qualified High -Technology Business(es).
6. Name of Person at the Innovations Center to contact for further information
7. Telephone Number
8. Mailing Address
PART 2: CERTIFICATION
I hereby certify, under penalty of perjury, that, to the best of my knowledge, the above-named company qualifies for the
exemption for an Innovations Center and that the information provided on this affidavit is true and correct.
9a. Type Name of Company Officer
10. Title
9b. Company Officer Signature
11. Date

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