Form 2691 - State Tax Commission Assessment Roll Certification (Assessor Of Record, Pre-March Board Of Review)

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Michigan Department of Treasury
L-4037
2691 (Rev. 05-11)
State Tax Commission Assessment Roll Certification
(Assessor of Record, Pre-March Board of Review)
This form is issued under the authority of the General Property Tax Act, P.A. 206 of 1893, MCL 211.10d. Attach original copy to the assessment roll.
PART 1: ASSESSOR AND LOCAL UNIT INFORMATION
(This form must be filed with the MBOR by the first Monday in March or by the specified charter deadline.)
Assessing Officer Name
Certification Number
Certification Level (MCAO, MAAO, MMAO)
Tax Year
Local Unit of Government Name
County Name
City or Township
PART 2: PRE-BOARD OF REVIEW ASSESSED VALUES, CAPPED VALUES AND TENTATIVE TAXABLE VALUES – AD
VALOREM AND SPECIAL ACTS
Property Class
Assessed Values
Capped Values
Tentative Taxable Values
Real Agriculture
Real Commercial
Real Industrial
Real Residential
Real Timber Cutover
Real Developmental
TOTAL REAL
PROPERTY
TOTAL PERSONAL
PROPERTY
TOTAL OF REAL AND
PERSONAL PROPERTY
PART 3: ASSESSOR CERTIFICATION
I hereby certify that the information contained within this Assessor of Record Assessment Roll Certification is true and accurate to the best of my
knowledge, information and belief and that the valuations were prepared by myself as the assessing officer of record and pursuant to the guidelines
found within the State Tax Commission’s Supervising Preparation of the Assessment Roll document. I further certify that I have determined
that the Ad Valorem and Special Acts assessed, capped and tentative taxable valuations contained within this Assessor Certification Statement
compose the aggregate assessed valuations of taxable property for the above mentioned local unit of government prior to the March Board
of Review.
Assessing Officer Signature
Date

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