Form 4175 - Application To Purchase Tax Foreclosed Property - County Government

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Michigan Department of Treasury

TREASURY USE ONLY

4175 (Rev. 4-06)

Date Application Received Date Application Reviewed

Application to Purchase Tax Foreclosed Property -

County Government

Payment Amount

Deed Number

Issued under the authority of 206 PA 1893; Section 211.78(m). This information is required to

issue a deed.

Deed Date

Deed Mail Date

INSTRUCTIONS: File this completed form and payment via certified check by the instructed

deadline. Make check payable to State of Michigan. Late applications will be rejected.

PART 1: APPLICANT INFORMATION

Governmental Agency Name

Address (Street Number, P.O. Box)

City

State

ZIP Code

PART 2: DEED ISSUANCE

Issue deed to:

Same as Governmental Agency in Part 1

Grantee Name

Address (Street Number, P.O. Box)

City

State

ZIP Code

Mail deed to:

Address (Street Number, P.O. Box)

City

State

ZIP Code

PART 3: BIDDING INFORMATION

Minimum Bid as

County

Sale Number

Local Parcel Number

Identified on

Treasury Web Site

Treasury Application Fee

$300.00

Check this box if additional parcels are attached.

TOTAL

PART 4: CERTIFICATION

By signing below, I understand that the land herein described shall be used solely for public purposes. The deed issued by the State of Michigan may

reserve to the State of Michigan all mineral rights including coal, oil and gas, etc., rights of ingress and egress over and across any watercourse or

stream, pursuant to the provisions of Public Act 451 of 1994, as amended and all aboriginal antiquities, mounds, earthworks, etc., pursuant to the

provisions of Public Act 451 of 1994.

Representative Name

Title

Representative Signature

Date

Telephone Number

Return Completed Application to:

Property Services Division

Questions may be directed to (517) 335-3253.

Michigan Department of Treasury

P.O. Box 30760