Form 3883 - Municipal Finance Qualifying Statement Worksheet
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Michigan Department of Treasury
3883 (Rev. 5-06)
Municipal Finance Qualifying Statement Worksheet
Issued under the authority of P.A. 34 of 2001.
INSTRUCTIONS. Use this worksheet as your guide to submit your information on-line site by following these steps:
1. Go to the Department's Web site at
2. Next, click on "Local Government."
3. Then select "Municipal Finance."
4. Finally, select "Online Qualifying Statement" from the list.
Direct questions to (517) 373-0660 or e-mail to Treas_MunicipalFinance@michigan.gov
MUNICIPALITY INFORMATION
Legal Name of Municipality
County(ies)
Municipality Type
Most Recently Completed Fiscal Year End Date (month/year)
Most Recent State Equalized Value
Year
Most Recent Taxable Value
Year
Most Recent Population
Year
GENERAL INFORMATION
1.
Has the local unit been in default on any security/debt, excluding IDR bonds, EDC bonds, bonds issued by
Yes
No
a local hospital finance authority, or any other debt for which the municipality is not financially liable?
2.
Was the local unit required to levy a tax as a result of a court order or judgment during the preceding fiscal
Yes
No
year?
3.
Are all outstanding securities of the municipality authorized by statute? If there are no outstanding
Yes
No
securities, answer “YES”
4.
Is the municipality in violation of any provision in the covenants for an outstanding security, including but
not limited to short-term municipal security set-aside requirements; statutory debt limitations for short-term
Yes
No
municipal securities; and required funding levels for revenue bond reserve accounts
5.
Did the municipality submit a qualifying statement or an application for any other security in the preceding
Yes
No
18 months that was materially false or incorrect?
6.
Did the municipality issue a refunding security in the preceding fiscal year to avoid a potential default on
Yes
No
an outstanding security?
AUDIT REPORT (most recent as required by statute)
Yes
No
7.
Was the most recent audit report filed with Treasury within 6 months from the end of the fiscal year?
8.
Are there any unreserved fund balance deficits in ANY funds or retained earnings deficit for any
Yes
No
enterprise funds? If "NO," go to question #10
Yes
No
9.
If there were deficits, has a deficit elimination plan been filed with Treasury?
10. Enter the total fund balance remaining in all unlimited tax levy funded debt retirement funds at the end of
the most recent fiscal year
11. Enter the total amount of principal and interest due in the next fiscal year for all unlimited tax
levy debt
Continued on page 2.
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Parent category: Financial