Form 272 - Proof Of Publication Affidavit printable pdf download

Form 272 - Proof Of Publication Affidavit

Michigan Department of Treasury

This form is issued under the authority of

272 (Rev. 1-07)

Public Act 206 of 1893; MCL 211.66 and

211.78o(1)(b).

PROOF OF PUBLICATION AFFIDAVIT

INSTRUCTIONS:

PUBLISHER: Prepare in triplicate. Send all affidavits, with a copy of the final publication attached, to

to the County Clerk

County of ___________________________________

_____________________________________________________________ being duly sworn, testifies that he/she

is _________________________________________ of the ___________________________________________

a newspaper published at ___________________________________ and circulated in the above county and that

he/she is familiar with the facts and that the notice, a copy of which is attached, was published in said newspaper

once each week for three consecutive weeks (three publications) prior to the time fixed for the hearing thereof, and

that the publications were made on the:

______________________________________ day of ____________________________________ 20 ________

______________________________________ day of ____________________________________ 20________

Dated _____________________

_______________________________________________

Signature of Publisher

State of Michigan

)

) ss

County of ______________________________

)

On the ________________ day of _________________ 20 ________, the foregoing instrument was acknowledged

before me by ________________________________________.

______________________________________________

Notary Public

My Commission expires _________________________

Form 272 - Proof Of Publication Affidavit