Form 3676 - Affidavit Attesting That Qualified Agricultural Property Shall Remain Qualified Agricultural Property

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Michigan Department of Treasury, PTD
3676 (8-00)
This form is issued under authority of
P.A. 260 of 2000. Filing is mandatory.
AFFIDAVIT ATTESTING THAT QUALIFIED AGRICULTURAL PROPERTY
SHALL REMAIN QUALIFIED AGRICULTURAL PROPERTY
This form must be filed to claim that a transfer of property is not a statutory transfer of ownership because the property
will continue to be qualified agricultural property. This form must be filed with the assessor of the local tax collecting unit in
which the qualified agricultural property is located and with the register of deeds for the county in which the qualified
agricultural property is located.
1. Street Address of Property
2. County
3. City/Township/Village Where Real Estate is Located
City
Township
Village
4. Name of Property Owner(s) (Please Type or Print)
5. Property ID Number (from Tax Bill or Assessment Notice)
6. Legal Description (Legal description is required;
7. Percentage of This Property Which is Currently
attach additional sheets if necessary)
and Will Remain Qualified Agricultural Property
CERTIFICATION
I certify that the information above is true and complete to the best of my knowledge. I further certify that the property noted
on this affidavit currently is and will remain qualified agricultural property.
Owner's Signature
Date
If signer is not an owner, print name and title
NOTARIZATION (Necessary for recording with Register of Deeds)
Signed __________________________________
State of ________________________________
County of _______________________________
Title ____________________________________
Subscribed and sworn to before me this _____________________
day of _________________________________, ______________
Must be signed by owner, partner, corporate
By ___________________________________________________
officer, or a duly authorized agent
My commission expires __________________________________
Do not write below this line -- for local government use only.
Is the percentage stated above in number 7 the current percentage of the property
that is qualified agricultural property?
Yes
No
If not, what is the correct percentage of the property that is currently qualified agricultural property? _______________
Assessor's Signature
Date

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