Form 4075 - Notice Of Denial Of Principal Residence Exemption Page 2
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1
2Instructions for Form 4075,
Notice of Denial of Principal Residence Exemption
(County)
General Instructions
This form is for county Treasurers or Equalization Directors
Line 12: Check the box indicating the reason the principal
to use when notifying a homeowner that his or her principal
residence exemption was denied. If none apply, check
"other" and enter a more detailed explanation of your reasons
residence exemption is denied. It will also be used to notify the
for denial. Be specific and as complete as possible. The
Department of Treasury of the denial. Complete all information
information you provide in this section may be used in the
carefully and accurately to avoid processing errors.
appeals process.
Mail a copy to Treasury with a copy of Form 2753, Batch
Line 13: Enter all years that are being denied. (You have
Cover for Principal Residence Exemption. Label them as
the authority to deny the current year and the three
denials.
preceding years.)
Mail the original to the homeowner. Their appeal rights are
Line 14: Enter the percentage of which the principal residence
printed on the bottom of the form. Make a copy for your
exemption has been adjusted to.
.
records
Line-by-Line Instructions
Line 15: Signature. This form must be signed by either the
county Treasurer or Equalization Director. Indicate who is
IMPORTANT: Complete a separate form for each
denying exemption.
property being denied.
Line 16: Date. The homeowner has only 35 days to appeal
Line 1: You must complete this line. Do not enter more
an exemption denial. The date you enter here is the starting
than one property identification (PIN) on each form. The
date for the homeowner's appeal time. Mail all forms the
PIN should be identical to the number used on the original
day they are signed.
affidavit.
Line 17: Enter the address and telephone number of the
Lines 2-6: Enter the complete address of the property you are
proper contact person at the local government.
claiming. Enter name and check the appropriate box for the
city or township in which the principal residence is located.
Additional Forms or Questions?
Insert the local revenue share code (6 digits) for the unit in
This form is available on our Treasury Web site at:
which the property is located in box 4.
Lines 7-10: Enter the name and social security number(s) of
the legal owner(s) that occupy the property.
If you have questions call 517-373-1950.
Line 11: Enter the mailing address if it is different from the
address on line 2.
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