Form 4887 - Economic Vitality Incentive Program/county Incentive Program Certification Of Consolidation Of Services

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Michigan Department of Treasury
4887 (Rev. 09-13)
Economic Vitality Incentive Program/County Incentive Program
Certification of Consolidation of Services
Issued under authority of 2013 Public Act 59. Filing is mandatory to qualify for payments.
Each city/village/township/county applying for Consolidation of Services payments must:
1. Certify to the Michigan Department of Treasury (Treasury) that the local unit listed below has produced and made readily
available to the public, a Consolidation Plan as required by 2013 Public Act 59. 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 a Consolidation Plan.
City/village/township: This certification, along with a Consolidation Plan, must be received by February 1, 2014 to receive the
February and April payments or on or before March 31, 2014 to receive the April payment. Post mark dates will not be considered.
For questions, call (517) 373-2697.
County: This certification, along with a Consolidation Plan, must be received by February 1, 2014 (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
Extension
Website Address, if plan is available online
PART 2: CERTIFICATION
In accordance with 2013 Public Act 59, the undersigned hereby certifies to Treasury that the above mentioned local unit has
produced a Consolidation 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 Consolidation 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, fax to (517) 335-3298, or 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 Eligible
EVIP/CIP Notes
Y
N
Final Certification
Plan Received
1st C/P Submission
Y
N

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