Form 2995 - 2001 Declaration Regarding Personal Property Statement(S) Containing A Facsimile Signature - Michigan Department Of Treasury

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Michigan Department of Treasury
2995 (Rev. 8-00)
2001 Declaration Regarding Personal
Property Statement(s) Containing
A Facsimile Signature
Public Act 126 of 1996 states that a facsimile signature may be used on a personal property statement
provided that a person using the facsimile signature has filed this declaration with the State Tax Commis-
sion for each year that the facsimile signature is used. A facsimile signature is a copy or a reproduction of an
original signature. This declaration must be made under oath. A taxpayer who wishes to use a facsimile
signature in 2001 must complete items 1 and 2 below and mail this declaration to the State Tax
Commission.
(1)
PLACE THE FACSIMILE SIGNATURE ON THE LINE BELOW:
_________________________________________
(2)
State of ___________________________,
ss
County of _________________________
I, ____________________________________________, being duly sworn, depose and say that each
personal property statement containing the facsimile signature printed above is a true and correct statement
of all tangible personal property owned or held by ___________________________________ in the
assessing district for which the statement is made, on the THIRTY-FIRST (31st) DAY OF DECEMBER
2000.
Subscribed and sworn to before me this ________
Signed _________________________________
day of ___________________________, ______
Title ___________________________________
________________________________________
Must be Signed by Owner, Partner or
(Signature of Notary Public)
Corporate Officer or a duly authorized agent.
My Commission Expires ___________________
Name and Address of Company (City, State, ZIP)
(3)
MAIL THIS DECLARATION TO:
Michigan State Tax Commission
P.O. Box 30471
Lansing, MI 48909-7971
Telephone No.
(
)

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