Form 3676 - Affidavit Attesting That Qualified Agricultural Property Shall Remain Qualified Agricultural Property

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Michigan Department of Treasury
This form is issued under authority of P.A. 260 of
3676 (Rev. 3-10)
2000 and P.A. 378 of 2006. Filing is mandatory.
Affidavit Attesting that Qualified Agricultural Property or Qualified Forest
Shall Remain Qualified Agricultural Property
INSTRUCTIONS: This form must be filed to claim that a transfer of property is not a statutory transfer of ownership because the
property will continue to be qualified agricultural or qualified forest property. This form must be filed with the register of deeds for the
county in which the qualified agricultural property is located and then with the assessor of the local tax collecting unit where this
property is located.
1. Street Address of Property
2. County
3. City/Township/Village Where Real Estate is Located
City
Township
Village
4. Name of Property Owner(s) (Print or Type)
5. Property ID Number (from Tax Bill or Assessment Notice)
6. Legal Description (Legal description is required; attach additional sheets if
7. Percentage of This Property Which is Currently and Will Remain Qualified
necessary)
Agricultural Property (#7 does not apply to the Qualified Forest Program)
8. Daytime Telephone Number
9. E-mail Address
CERTIFICATION & NOTARIZATION (Notarization necessary for recording with Register of Deeds)
I certify that the information above is true and complete to the best of my knowledge. I further certify that the property noted on this
affidavit currently is and will remain qualified agricultural or qualified forest property.
Signed __________________________________
Name (Print or Type)_______________________
Title ____________________________________
Notary Public, State of Michigan,
Must be signed by owner, partner, corporate
County of ________________________________
officer, or a duly authorized agent.
My commission expires: ____________________
State of ________________________________
Acting in the County of______________________
County of _______________________________
Acknowledged before me this ___________________________
Drafter's Name ___________________________
Drafter's Address _________________________
day of _________________________________, ______________
_______________________________________
By___________________________________________________
Notary Signature _______________________________________
Name of Notary (Print or Type) ____________________________
LOCAL GOVERNMENT USE ONLY
Is the percentage stated above in number 7 the current percentage of the property
that is qualified agricultural property?
Yes
No
N/A (Qualified Forest Only)
If not, what is the correct percentage of the property that is currently qualified agricultural property? _______________
Assessor's Signature
Date

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