Form 5005 - Foreclosure Entity Payment Form - Principal Residence Exemption (Pre)

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Michigan Department of Treasury
5005 (08-12)
Sheet
of
Foreclosure Entity Payment Form - Principal Residence Exemption (PRE)
Issued under authority of Public Act 206 of 1893.
Read instructions on page 2 before completing the form. Use additional copies of this form if necessarry. Summaries are due with remittance to the Department of Treasury on a monthly basis.
Governmental Agency Remitting Funds (City or Township)
County
Prepared by (Name and Title)
Date
Telephone Number
E-mail Address
Summer or
Property Identification
School Operating
Payment
Name of Entity
Property Address
Tax Year
Winter Levy
Taxable Value
Number
Millage Rate
Amount
(S or W)
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11. Total on this sheet (add lines 1 through 10) .....................................................................
11.
Mail form with supporting documents to:
Principal Residence Exemption Unit
12. Total on additional sheets (add lines 10 from other sheets) ............................................
12.
Michigan Department of Treasury
PO Box 30440
13. Total Foreclosure Entity Payment ................................................................................
13.
Lansing MI 48909
Deposit into School Aid Fund Index 62022, AOBJ 1123, TC190

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