Form 4888 - Economic Vitality Incentive Program/county Incentive Program Certification Of Employee Compensation

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Michigan Department of Treasury
4888 (08-12)
Economic Vitality Incentive Program/County Incentive Program
Certification of Employee Compensation
Issued under authority of 2012 Public Act 200. Filing of this form or Form 4978 Certification of 2011 Public Act 152 Compliance is mandatory to qualify for payments.
Each city/village/township/county applying for Employee Compensation payments must:
1. Certify to the Michigan Department of Treasury (Treasury) that the local unit listed below has developed and publicized
an employee compensation plan as required by 2012 Public Act 200. The plan shall be made available for public viewing
in the clerk’s office or posted on a publicly accessible Internet site.
2. Submit to Treasury an employee compensation plan.
City/village/township: This certification, along with the employee compensation plan, must be received by June 1, 2013 to
receive the June and August payments or on or before July 31, 2013 to receive the August payment. Post mark dates will not be
considered. For questions, call (517) 373-2697.
County: This certification, along with the employee compensation plan, must be received by June 1, 2013 (or the first day of
a payment month) in order to qualify for that month’s payment. Post mark dates will not be considered. For questions, call (517)
373-2697.
PART 1: LOCAL UNIT INFORMATION
Local Unit Name
Local Unit County Name
Local Unit Code
Contact E-Mail Address
Contact Name
Contact Title
Contact Telephone Number
Website Address, if plan is available online
PART 2: CERTIFICATION
In accordance with 2012 Public Act 200, the undersigned hereby certifies to Treasury that the above mentioned local unit has
developed an employee compensation plan and has made the plan available for public viewing in the city, village, township, or
county clerk’s office or has posted the plan on a publicly accessible Internet site. The employee compensation plan is attached to
this signed certification.
Chief Administrative Officer Signature (as defined in MCL 141.422b)
Printed Name of Chief Administrative Officer (as defined in MCL 141.422b)
Title
Date
Completed and signed form (including required attachment) should be e-mailed to: TreasRevenueSharing@michigan.gov
If you are unable to submit via e-mail, mail the completed form and required attachment to:
Michigan Department of Treasury
Office of Revenue and Tax Analysis
PO Box 30722
Lansing MI 48909
TREASURY USE ONLY
Certification Received
EVIP/CIP Notes
EVIP/CIP
Y
N
Final Certification
Plan Received

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