Form 4943 - County Treasurer Statement Of Rejected Real Property Taxes

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Michigan Department of Treasury
Form 4943 (02-12)
County Treasurer Statement of Rejected Real Property Taxes
This form is issued under authority of Public Act 206 of 1893; Section 110.
INSTRUCTIONS: Submit this completed request, along with a detailed statement showing a breakdown of taxes by taxing authority and
complete tax roll legal description, for each parcel and year taxes are being rejected, by June 30 of the current tax year.
The County Treasurer shall mail the completed statement and documentation to the Michigan Department of Treasury, Property Services
Division, PO Box 30760, Lansing MI 48909. Upon State Treasurer approval or rejection, the list shall be returned to the County Treasurer
for cancellation or reassessment.
PART 1: REJECTED TAXES PROPERTY INFORMATION
Local Parcel Number
Tax Year
Total Taxes Owing
Reason for Rejection
Rejected By
1.
2.
3.
4.
5.
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12.
PART 2: CERTIFICATION
I certify that this statement is correct and true as to the identification of parcels and their appropriate reasons for rejection.
County Treasurer Name
County
County Treasurer Signature
Phone Number
Date
STATE GOVERNMENT USE ONLY - DO NOT WRITE BELOW THIS LINE
On behalf of the State Treasurer, unless otherwise noted above, I approve the county’s rejection of the taxes as listed above.
State Treasurer Representative
Representative’s Title
Representative’s Signature
Date

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