Form 2368 - Principal Residence Exemption (Pre) Affidavit - 2009

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Michigan Department of Treasury
2368 (Rev. 04-09)
Reset Form
Principal Residence Exemption (PRE) Affidavit
Issued under authority of Public Act 206 of 1893.
Read the instructions page before completing the form. Completion of this Affidavit constitutes a claim for a Principal Residence Exemption
(PRE) when filed with the local assessor of the city or township where the property is located. Filing this Affidavit invalidates any previous
PRE the homeowner may have claimed. A Request to Rescind Principal Residence Exemption (PRE) (Form 2602) or a Conditional
Rescission of Principal Residence Exemption (PRE) (Form 4640) must be filed with the local assessor for any previous claims.
Print or type in blue or black ink. Use a separate form for each property number.
PART 1: PROPERTY INFORMATION
Name of City, Township or Village (taxing authority)
4Property Tax Identification Number
City
Township
Village
County
4Street Address of Property
4ZIP Code
4City
4State
4Owner’s First, Middle and Last Names
4Social Security Number
4Telephone Number
4Co-Owner’s First, Middle and Last Names
4Social Security Number
4Telephone Number
1. The property above is my ...................................
Principal Residence
Residential Unoccupied Contiguous or Adjacent Lot
4
4
2. Date the property became your principal residence (mm/dd/yyyy) ................................................................
3. If this parcel has more than one home on it, or if you own and live in one unit of a multiple-unit dwelling
(or a multi-purpose property) give the percentage of the entire property that your unit (your principal
4
%
residence) occupies. Your exemption will be based on this percentage .......................................................
4. Have you claimed a principal residence exemption for another Michigan principal residence? ..............................
Yes
No
5. If yes, have you rescinded that principal residence exemption? ..............................................................................
Yes
No
6. Do you or your spouse claim an exemption, credit or deduction on property located in another state? ..................
Yes
No
7. Have you or your spouse filed a tax return as a resident of another state? .............................................................
Yes
No
PART 2: CERTIFICATION
Owner’s Mailing Address (If different from property address above) City
State
ZIP Code
Closing Agent or Preparer’s First Name
Last Name
Closing Agent or Preparer’s Mailing Address
City
State
ZIP Code
Certification: I certify under penalty of perjury the information contained on this document is true and correct to the best of my knowledge.
Owner’s Signature
Date
Co-Owner’s Signature
Date
LOCAL GOVERNMENT USE ONLY (do not write below this line)
Was an exemption in place prior to this affidavit being filed?
4 First year exemption to be posted to tax rolls?
Property Classification
Yes
No

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