Form 3711 - Report Of Heavy Earth Moving Equipment Claimed As Exempt Inventory

Michigan Department of Treasury

3711 (1-01)

Report of Heavy Earth Moving Equipment Claimed as Exempt Inventory

Issued under authority of P.A. 317 of 2000.

Taxpayer Name

Telephone Number

Assessment Year

Assessment Jurisdiction

Taxpayer Address (Street or RR#, City, State ZIP)

Do you have other property in this jurisdiction that is subject to assessment?

Yes

No

If Yes, complete Form 632, formerly L-4175.

Common Description

Month & Year

Subject of

(e.g. Bulldozer),

Make

Serial

First Placed In

Usual Selling

Name of

Date of

Prior Lease(s)?

Including Weight

and Model

Number

Service New

Price New

Lessee/User

Current Lease

(Yes or No)

Include as many pages as necessary to fully report your heavy earth moving equipment claimed to be exempt. For further information on completing this form and for determining whether

your equipment qualifies for exemption, see Tax Commission Bulletin 4 of 2001 which can be obtained from your local assessor or can be found with the State Tax Commission Bulletins

on the Michigan Department of Treasury Web site at

I certify that I am an owner, officer and/or duly authorized agent for the above named taxpayer, that the equipment described in the above report is qualified for exemption pursuant to P.A. 317 of 2000 and that

the contents of this report are true to the best of my knowledge and belief.

Page _____ of ______

Signature

Printed Name

Title (Owner/Officer, etc.)

Date

(If this report consists of more than

1 page, you are required to sign

the last page)