Form 2748 - Senior Citizen Or Totally And Permanently Disabled Person'S Affidavit Requesting Special Assessment Deferment
Download a blank fillable Form 2748 - Senior Citizen Or Totally And Permanently Disabled Person'S Affidavit Requesting Special Assessment Deferment in PDF format just by clicking the "DOWNLOAD PDF" button.
Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.
Complete Form 2748 - Senior Citizen Or Totally And Permanently Disabled Person'S Affidavit Requesting Special Assessment Deferment with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.
Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.
ADVERTISEMENT
1
2
3Reset Form
Michigan Department of Treasury
OFFICE USE ONLY
2748 (Rev. 3-07)
File No.
Senior Citizen or Totally and Permanently Disabled
Person's Affidavit Requesting Special Assessment Deferment
1. Filer's First Name and Middle Initial
Last Name
2a. Your Social Security No.
2b. Your Date of Birth
If a Joint Return, Spouse's First Name and Middle Initial Last Name
3a. Spouse's Social Security No.
3b. Spouse's Date of Birth
Home Address (number and street or RR#)
City or Town
State
ZIP Code
4. Home Telephone Number
PART l - ELIGIBILITY DETERMINATION (This part to be completed by applicant)
See instructions on reverse side
5.
Are you (a) citizen(s) of the United States?
Yes
No
6.
Have you been (a) resident(s) of Michigan for five years or more?
Yes
No
7.
Have you been the sole owner(s) of the homestead for five or more years?
Yes
No
8.
What is the type or purpose of the special assessment?
9.
When is the next installment payment due on the special assessment?
Month
Day
Year
$
10.
Total household income for the past calendar year
11.
a. Is there a mortgage or land contract on your homestead?
Yes
No
b. Has the mortgagee or land contract holder on your homestead consented to this request
for a special assessment deferment? (A copy of the written consent MUST BE ATTACHED)
Yes
No
c. Are you totally and permanently disabled and receiving benefits under Social Security?
Yes
No
12.
I (we) declare under penalty of perjury that I (we) qualify for the deferment of special assessments on this homestead as defined in
Public Act 225 of 1976, as amended; that I (we) have examined this affidavit and to the best of my (our) knowledge and belief it is true,
correct and complete; and I (we) acknowledge that the amount of the assessment deferred will be subject to an interest rate of 1/2 of 1
IF THIS DEFERMENT IS
percent per month or fraction of a month (6 percent per year) when the deferment is repaid to the State.
AUTHORIZED, THE STATE WILL PLACE A LIEN ON YOUR PROPERTY.
Signature
Date
Spouse's Signature
Date
PART ll - DEFERRED TAX ASSESSMENT COMPUTATION (To be completed by local assessor)
See instructions on reverse side.
13.
Original amount of special assessment (must be $300.00
$
or more to qualify; attach tax bill)
$
14.
Amount paid on special assessment by owner
$
15.
a. Amount of assessment to be deferred (line 13 less line 14)
b. Amount of line 15a which is delinquent (attach tax bill) to:
$
Local Unit
$
County
16. Complete legal description of owned and occupied homestead:
17.
I have examined the above affidavit and determined that the amount claimed is correct. The above named applicant(s) is (are) aware of the 1/2
of 1 percent per month or portion of a month interest provision. The consent of the mortgagee or land contract holder, if applicable, is attached and
the requirements of Public Act 225 of 1976, as amended, have been satisfied by the applicant(s).
Assessing Officer Signature
County
City, Village or Township
Federal Employer I.D. Number
Assessor Telephone Number
This is a loan to the property owner by the State of Michigan. A lien will be placed on the property.
The lien will not be removed until the loan has been repaid at the time of sale or transfer of the property.
ADVERTISEMENT
0 votes
Related Articles
Related forms
Form 2748 - Senior Citizen Or Totally And Permanently Disabled Person's Affi Davit Requesting Special Assessment Deferment
Financial
Heal Form 539 - Physician's Certification Of Borrower's Total And Permanent Disability - U.s. Department Of Education
Legal
Related Categories
Parent category: Financial