Form 627 - Assessor Or Equalization Director'S Notice Of Property Incorrectly Reported Or Omitted From Assessment Roll Page 2

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627, Page 2

TAX RATE INFORMATION (to be completed by the assessor)

If this notice is for either of the tax years immediately preceding the current year, the assessor shall list for each year the total tax rate levied in the city

or township in which the property is located. The total annual tax rate levied must include the total village tax rate, if applicable. The listing must reflect

any millage reduction due to the Principal Residence Exemption, the Qualified Agricultural Exemption, the Qualified Forest Exemption, the Industrial

Facilities Exemption, the Commercial Personal Property Exemption or the Industrial Personal Property Exemption. If this notice is for omitted real

property upon which "millage rate" special assessments were levied, list those rates separately below. Do not include special assessments levied in

specific dollar amounts.

SUMMER

WINTER

Year Covered By Notice

Total Annual Tax Rate Levied

Total Tax Rate Levied

SPECIAL ASSESSMENT RATES. Complete lines below for special assessment millage rates only

Year Covered By Notice

SUMMER

WINTER

Total Annual

Special Assessment Rate Levied

SIGNATURE

Signature of Assessor or Equalization Director

Date

INSTRUCTIONS: The State Tax Commission's jurisdiction under MCL 211.154 is limited to correcting assessments for the current

assessment year (the year of discovery and disclosure to the Commission) and two immediately preceding years. Although you must

present a copy of this form to the property owner for concurrence or disagreement, you may also immediately submit a second copy of

this form, without the owner's concurrence or disagreement, to the State Tax Commission. Your failure to do so by December 31 of

the current calendar year may affect the Commission's jurisdiction to consider all of the assessment years that you have included on

this form.

OWNER'S CONCURRENCE OR DISAGREEMENT WITH THIS REQUEST

This section shall be completed by the property owner and the form returned to the assessor.

I AGREE with this request for corrected Assessed Value and/or Taxable Value.

I DO NOT AGREE with this request for corrected Assessed Value and/or Taxable Value. The owner who checks this box must submit to the

assessor an explanation of the reason for not concurring.

Comments or Explanations

Did the property covered by this notice change ownership during the time period starting with the earliest year for which a change is being requested,

up to the present?

Yes

If yes, give date.

Signature of Property Owner

Date

Telephone Number

Email Address

Return this completed form to the Assessor.