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Michigan Department of Treasury
4813 (Rev. 03-13)
Assessor’s Affidavit to Waive Principal Residence Exemption (PRE) Denial Interest
Issued under authority of Public Act 206 of 1893.
Read the instructions before completing the Affidavit. This Affidavit must be completed and certified by the assessor and all of the
appropriate documents must be attached in order for the Department of Treasury (Treasury) to consider waiving interest on a corrected or
supplemental tax bill. Treasury will consider, but is not required to, waive interest only for errors detailed in Subsection 8 of MCL 211.7cc.
Use a separate form for each property tax identification number.
PART 1: PROPERTY INFORMATION —
Attach a copy of the letter from the property owner requesting the waiver.
Property Tax Identification Number
Street Address
County
Township or City Name (Check appropriate box, write in name)
ZIP Code
Township
City
Owner’s First and Middle Names
Owner’s Last Name
Owner’s Daytime Telephone Number
Co-owner’s First and Middle Names
Co-owner’s Last Name
Co-owner’s Daytime Telephone Number
Mailing Address
City
State
ZIP Code
PART 2: PRE DENIAL AND INTEREST INFORMATION
Who denied the PRE that resulted in the corrected or supplemental tax bill(s)? (Attach a copy of the denial notice.)
Department of Treasury
County
Township/City Assessor
Who issued the corrected or supplemental tax bill(s)? (Attach a copy of the tax bill(s).)
Department of Treasury
County
Township/City Assessor
In the table below, list the details, by year, of the corrected or supplemental tax bill(s) under review.
TAx YEAR
TAx AMOuNT
INTEREST AMOuNT
TOTAL AMOuNT
What is the total interest that Treasury should consider waiving?
PART 3: ERROR INFORMATION —
Attach a copy of supporting documents. See instructions for details.
A. Was the corrected or supplemental tax bill(s) a result of an assessor’s classification error?
Yes
No
If answered “yes,” explain here (use additional sheets if necessary):
B. Was the corrected or supplemental tax bill(s) a result of an assessor’s failure to rescind the
Yes
No
exemption after the owner requested, in writing, that the exemption be rescinded?
If answered “yes,” explain here (use additional sheets if necessary):
C. Was the corrected or supplemental tax bill(s) a result of some other error?
Yes
No
If answered “yes,” explain here (use additional sheets if necessary):
Continue on Page 2.