Form 2691 - State Tax Commission Assessment Roll Certification (Assessor Of Record, Pre-March Board Of Review) Page 2

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Michigan Department of Treasury
L-4037
Form 2691, page 2 (Rev. 05-11)
State Tax Commission Assessment Roll Certification (Board of Review)
This form is issued under the authority of the General Property Tax Act, P.A. 206 of 1893, MCL 211.30. Attach original copy to the assessment roll.
PART 1: ASSESSOR AND LOCAL UNIT INFORMATION
Assessing Officer Name
Certification Number
Certification Level (MCAO, MAAO, MMAO)
Tax Year
Local Unit of Government Name
County Name
City or Township
PART 2: POST-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: BOARD OF REVIEW CERTIFICATION
We hereby certify that the information contained within this Board of Review Assessment Roll Certification is true and accurate to the best of our
knowledge, information and belief and that the Ad Valorem and Special Acts assessed, capped and tentative taxable valuations contained within
this Board of Review Certification compose the aggregate assessed valuations of taxable property for the above mentioned local unit of government
following the conclusion of the Board of Review.
Chairperson of the Board of Review Signature
Date
Board of Review Member Signature
Date
Board of Review Member Signature
Date
Board of Review Member Signature (if necessary)
Date
Board of Review Member Signature (if necessary)
Date
Board of Review Member Signature (if necessary)
Date

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