Form 4886 - Economic Vitality Incentive Program/county Incentive Program Certification Of Accountability And Transparency
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Michigan Department of Treasury
4886 (Rev. 09-13)
Economic Vitality Incentive Program/County Incentive Program
Certification of Accountability and Transparency
Issued under authority of 2013 Public Act 59. Filing is mandatory to qualify for payments.
Each city/village/township/county applying for Accountability and Transparency 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 Citizen’s Guide, a Performance Dashboard, a Debt Service Report and a Projected Budget Report
as required by 2013 Public Act 59. The Citizen’s Guide, Performance Dashboard, Debt Service Report and Projected Budget
Report 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 Citizen’s Guide, a Performance Dashboard, a Debt Service Report and a Projected Budget Report.
City/village/township: This certification, along with a Citizen’s Guide, a Performance Dashboard, a Debt Service Report and a Projected
Budget Report, must be received by October 1, 2013 to receive the October and December payments or on or before November 30,
2013 to receive the December payment. Post mark dates will not be considered. For questions, call (517) 373-2697.
County: This certification, along with a Citizen’s Guide, a Performance Dashboard, a Debt Service Report and a Projected Budget
Report, must be received by October 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
Extension
Website Address, if reports are 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
Citizen’s Guide, a Performance Dashboard, a Debt Service Report and a Projected Budget Report and has made them available for public
viewing in the city, village, township, or county clerk’s office or has posted them on a publicly accessible Internet site. The Citizen’s Guide,
Performance Dashboard, Debt Service Report and Projected Budget Report are 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 attachments) 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 attachments to:
Michigan Department of Treasury
Office of Revenue and Tax Analysis
PO Box 30722
Lansing, MI 48909
TREASURY USE ONLY
EVIP/CIP Eligible
Certification Received
EVIP/CIP Notes
Y
N
Final Certification
Citizen’s Guide Received
Performance Dashboard Received
Debt Service Report Received
Projected Budget Report Received
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