Form 3674 - Application For Obsolete Property Rehabilitation Exemption Certificate

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Michigan Department of Treasury

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3674 (Rev. 05-13)

Application for Obsolete Property Rehabilitation Exemption Certificate

This form is issued as provided by Public Act 146 of 2000, as amended. This application should be filed after the district is established. This project will

not receive tax benefits until approved by the State Tax Commission. Applications received after October 31 may not be acted upon in the current y ear.

This application is subject to audit by the State Tax Commission.

INSTRUCTIONS: File the original and two copies of this form and the required attachments with the clerk of the local government unit.

(The State Tax Commission requires two copies of the Application and attachments. T he original is retained by the clerk.) Pleas e see

State Tax Commission Bulletin 9 of 2000 for more information about the Obsolete Property Rehabilitation Exemption. The following

must be provided to the local government unit as attachments to this application: (a) General de scription of the obsolete facil ity (year

built, original use, most recent use, number of stories, square footage); (b) General description of the proposed use of the rehabilitated

facility, (c) Description of the general nature and extent of the rehabilitation to be undertaken, (d) A descriptive list of the fixed building

equipment that w ill be a part of the r ehabilitated facility, (e) A time schedule for undertaking and completing the rehabilitat ion of the

facility, (f) A statement of the economic advantages expected from the exemption. A statement from the assessor of the local unit of

government, describing the required obsolescence has been met for this building, is required with each application. Rehabilitation may

commence after establishment of district.

Applicant (Company) Name (applicant must be the OWNER of the facility)

Company Mailing address (No. and street, P.O. Box, City, State, ZIP Code)

Location of obsolete facility (No. and street, City, State, ZIP Code)

City, Township, Village (indicate which)

County

Date of Commencement of Rehabilitation (mm/dd/yyyy)

Planned date of Completion of Rehabilitation

School District where facility is located

(include school code)

(mm/dd/yyyy)

Estimated Cost of Rehabilitation

Number of years exemption requested

Attach Legal description of Obsolete Property on separate

sheet

Expected project likelihood (check all that apply):

Increase Commercial activity

Retain employment

Revitalize urban areas

Increase number of residents in the

Create employment

Prevent a loss of employment

community in which the facility is situated

Indicate the number of jobs to be retained or created as a result of rehabilitating the facility, including expected construction employment _____

Each year, the State Treasurer may approve 25 additional reductions of half the school operating and state education taxes for a period not to exceed six years. Check the

following box if you wish to be considered for this exclusion.

APPLICANT'S CERTIFICATION

The undersigned, authorized officer of the company making this application certifies that, to the best of his/her knowledge, no information contained

herein or in the attachments hereto is false in any way and that all of the information is truly descriptive of the property for which this application is being

submitted. Further, the undersigned is aware that, if any statement or information provided is untrue, the exemption provided by Public Act 146 of 2000

may be in jeopardy.

The applicant certifies that this application relates to a rehabilitation program that, when completed, constitutes a rehabilitated facility, as

defined by Public Act 146 of 2000, as amended, and that the rehabilitation of the facility would not be undertaken without the applicant's

receipt of the exemption certificate.

It is further certified that the undersigned is familiar w ith the provisions of Public Act 146 of 2000, as amended, of the Mich igan Compiled Laws; and to

the best of his/her knowledge and belief, (s)he has complied or will be able to comply with all of the requirements thereof which are prerequisite to the

approval of the application by the local unit of government and the issuance of an O bsolete Property Rehabilitation Exemption Certificate by the State

Tax Commission.

Name of Company Officer (no authorized agents)

Telephone Number

Fax Number

Mailing Address

Email Address

Signature of Company Officer (no authorized agents)

Title

LOCAL GOVERNMENT UNIT CLERK CERTIFICATION

The Clerk must also complete Parts 1, 2 and 4 on Page 2. Part 3 is to be completed by the Assessor.

Signature

Date application received