Form 4775 - Application For Neighborhood Enterprise Zone Certificate

Download a blank fillable Form 4775 - Application For Neighborhood Enterprise Zone Certificate 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 4775 - Application For Neighborhood Enterprise Zone Certificate 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.

Reset Form

Michigan Department of Treasury

State USe Only

4775 (Rev. 4-10), Page 1

4Application No.

4Date Received

application for neighborhood enterprise

Zone Certificate

Issued under authority of Public Act 147 of 1992, as amended.

Read the instructions before completing the application. This application must be filed prior to building permit issuance and start of

construction. Initially file one original application (with legal description) and two additional copies of this form with the clerk of the local

governmental unit (three complete sets). The additional documents to complete the application process will be required by the State

of Michigan only after the original application is filed with the clerk of the local governmental unit (LGU). This form is also used to file a

request for the transfer of an existing NEZ certificate. Please see the instruction sheet.

PaRt 1: OwneR/aPPlicant infORmatiOn

(Applicant must complete all fields)

Applicant Name

Type of Approval Requested

New

Rehabilitation

Transfer (1 copy only)

Facility

Facility’s Street Address

Amount of years requested

Is the facility owned or rented by occupants?

for exemption (6-15)

City

State

ZIP Code

Owned

Rented

Name of City, Township or Village (taxing authority)

Type of Property

House

Duplex

City

Township

Village

Condo

Loft

County

School District

Apartment - No. of Units _________

Name of LGU that established district

Name or Number of Neighborhood Enterprise Zone

Date district was established

Identify who the work was completed by

Estimated Project Cost (per unit)

Licensed Contractor

Other _________________________

Describe the general nature and extent of the new construction or rehabilitation to be undertaken. include Breakdown of investment cost. Use attachments if necessary.

Timetable for undertaking and completing the rehabilitation or construction of the facility.

PaRt 2: aPPlicant ceRtificatiOn

Contact Name

Contact Telephone Number

Contact Fax Number

Contact E-mail Address

Owner/Applicant Name

Owner/Applicant Telephone Number

Owner/Applicant Mailing Address (Street No., City, State, ZIP Code)

Owner/Applicant E-mail Address

I certify the information contained herein and in the attachments are true and that all are truly descriptive of the residential real property for which this

application is being submitted.

I certify I am familiar with the provisions of Public Act 147 of 1992, as amended, (MCL 207.771 to 207.787) and to the best of my knowledge, I have

complied or will be able to comply with all of the requirements thereof which are prerequisite to the approval of the application by the LGU and the

issuance of Neighborhood Enterprise Zone Certificate by the State Tax Commission.

Owner/Applicant Signature

Date

Continue on Page 2