Application For Deferment Of Summer And Winter Taxes For Tax Year
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1
2Application for Deferment
of Summer and Winter Taxes
For Tax Year ________
See General Information on Back of Form
Applicant’s Name (Last, First, Initial)
Parcel ID Number
Address (Number and Street)
□ City
Name of City, Village, or Township
□ Village
□ Township
SUMMER / WINTER DEFERMENT:
I hereby request that the treasurer of the municipality where I reside defer without penalty and interest
the due date of taxes on my principal residence identified above for the following:
□ Summer Taxes Only (Payment due February 14)
□ Winter Taxes Only (Payment due April 30)
□ Summer and Winter Taxes (Payment due April 30)
□
I certify that my gross household income for the preceding calendar year did not exceed $40,000
and that I qualify for the deferment provided for in the General Property Tax Act under the classification
marked below, and that the Homestead Property Tax Credit Claim must be filed on or before February
14th. (and check one below)
□ 62 years of age or older, including the unmarried surviving spouse of a
person who was 62 years of age or older at the time of death.
□ Paraplegic or Quadriplegic
□ Eligible Serviceperson, Eligible Veteran, Eligible Widow or Widower
□ Blind
□ Totally and Permanently Disabled
SPECIAL AGRICULTURAL SUMMER DEFERMENT:
I certify that I own the property, which is classified or used as agricultural real property, and the gross
receipts of agricultural or horticultural operations in the previous year (or the average gross receipts for
such operations in the previous three years) is not less than my household income for the preceding
calendar year.
□ Summer Taxes Only on Agricultural Property (Payment due February 14)
I understand that misleading or false statements on this application may subject me to
penalties and interest for late payment of taxes.
Applicant’s Signature
Date
After February 28th, please make property tax payments to:
Washtenaw County Treasurer
PO Box 8645, 200 N Main, Suite 200, Ann Arbor, MI 48107-8645.
FOR OFFICE USE ONLY
Municipality Approval Signature
Date
White - Local Unit
Yellow - County Treasurer
Pink - Applicant
Rev. 4/10
PLEASE WRITE FIRMLY
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