Form L-4156 - Notice Of Property Incorrectly Reported Or Omitted From The Assessment Roll Filed By A Person Other Than The Owner, Assessor Or Equalization Director Page 2

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629, Page 2
TAX RATE INFORMATION (To be completed by the assessor)
If this notice is for either of the tax years immediately preceding the current year, the assessor shall list for each year the total
tax rate levied in the city or township in which the property is located. The total annual tax rate levied must include the total
village tax rate, if applicable. The listing must reflect any millage reduction due to the Principal Residence Exemption, the
Qualified Agricultural Exemption, the Qualified Forest Exemption, the Industrial Facilities Exemption, the Commercial Property
Exemption or the Industrial Personal Property Exemption. If this notice is for omitted real property upon which "millage rate"
special assessments were levied, list those rates separately below. Do not include special assessments levied in specific dollar
amounts.
Year Covered
SUMMER
WINTER
Total Annual
by Notice
Total Tax Rate Levied
Total Tax Rate Levied
Tax Rate Levied
SPECIAL ASSESSMENT RATES. Complete lines below for special assessment millage rates only.
Year Covered
SUMMER
WINTER
Total Annual
by Notice
Special Assessment Rate Levied
Special Assessment Rate Levied
Special Assessment Rate Levied
Additional comments or explanation by Assessor. Attach additional pages if necessary:
ASSESSOR'S CONCURRENCE OR DISAGREEMENT WITH THIS REQUEST
This section must be completed by the assessor.
I CONCUR with this request for corrected Assessed Value and/or Taxable Value.
I DO NOT CONCUR with this request for corrected Assessed Value and/or Taxable Value. (The assessor who
checks this box must submit to the State Tax Commission an explanation of the reason for not concurring).
Name of Assessor
Title
Assessor Certificate Number
Address
Assessor Email Address
Assessor Signature
Date
Telephone Number
OWNER'S CONCURRENCE OR DISAGREEMENT WITH THIS REQUEST
This section must be completed by the property owner.
I AGREE with this request for corrected Assessed Value and/or Taxable Value.
I DO NOT CONCUR with this request for corrected Assessed Value and/or Taxable Value. (Theowner who
checks this box must submit to the State Tax Commission an explanation of the reason for not concurring).
Did the property covered by this notice change ownership during the time period starting with the earliest year for which a
change is being requested up to the present?
Yes
No
If yes, give date:
Signature of Property Owner
Date
Telephone Number
Return this completed form to:
Property Owner Email Address
State Tax Commission
Michigan Department of Treasury
P.O. Box 30471
Lansing, MI 48909-7971

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