Form 2368 - Principal Residence Exemption (Pre) Affidavit

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Michigan Department of Treasury

2368 (Rev. 04-13)

Principal Residence Exemption (PRE) Affidavit

Issued under authority of Public Act 206 of 1893.

Read the instructions page before completing the form. Completion of this Affidavit constitutes a claim for a Principal Residence Exemption

(PRE) when filed with the local assessor of the city or township where the property is located. The deadline to file the Affidavit for taxes levied

after December 31, 2011, is June 1 for the summer tax levy and November 1 for the winter tax levy. A Request to Rescind Principal Residence

Exemption (PRE) (Form 2602) or a Conditional Rescission of Principal Residence Exemption (PRE) (Form 4640) must be filed with the local

assessor for any previous claims. This form is not valid unless certified by the assessor. Do not submit this form if the property is not occupied by

the owner as a principal residence.

Type or print in blue or black ink. Use a separate form for each property tax identification number.

PART 1: PROPERTY INFORMATION

1. Property Tax Identification Number

2. ZIP Code

4. Name of Township or Village

3. Street Address of Property

Township

5. County

City

6. Date the property in line 1, above, became your principal residence ........................................................................ 46

Month

Day

Year

46a.

The property in line 1 above is my:

Principal residence

Unoccupied adjoining or contiguous property that is classified residential or timber-cutover.

46b.

7. Name of Owner (First, Middle, Last)

8. Owner’s Social Security Number

9. Name of Co-Owner (First, Middle, Last)

10. Co-Owner’s Social Security Number

11. Property owner’s daytime telephone number ........................................................................................................... 11.

12. List the percentage (100% to 1%) of the property that is occupied by the owner claiming the property as a

principal residence. If the property has more than one home on it, it is a multi-dwelling, used for purposes other

than a principal residence, or partially rented, the owner may claim only a partial exemption. Read the instruction

page attached to determine the percentage of the exemption the owner is allowed to claim in these situations. ..... 412.

13. Have you claimed a principal residence exemption for another Michigan principal residence? .............................. 13.

Yes

14. If yes, have you rescinded that principal residence exemption? .............................................................................. 14.

Yes

15. Do you or your spouse claim a similar exemption, credit or deduction on property located in another state? ......... 15.

Yes

16. Have you or your spouse filed a tax return as a non-resident of Michigan or resident of another state? ................ 16.

Yes

PART 2: CERTIFICATION

Certification: I certify under penalty of perjury the information contained on this document is true and correct to the best of my knowledge.

17. Owner’s Signature

17a. Co-Owner’s Signature

Date

17b. Mailing Address, if Different than Property Address Above

18. Closing Agent or Preparer’s Name and Mailing Address

LOCAL GOVERNMENT USE ONLY (do not write below this line)

19. Was an exemption in place prior to this affidavit being filed? ................................................................................. 19.

20. What is the first year this exemption will be posted to the tax rolls? ....................................................................... 420.

21. PRE applied with Summer Levy? ............................................................................................................................ 21.

Yes

22. PRE applied with Winter Levy? ............................................................................................................................... 22.

Yes

23. Indicate property classification ................................................................................................................................ 23.

Did the Assessor Approve or Deny the Affidavit?

What is the year the Affidavit will be posted to the tax roll?

Denied (Attach a copy of the Local Unit Denial)

Approved

Certification: I certify that, to the best of my knowledge, the information contained in this form is complete and accurate.

Assessor’s Signature

Date Certified by Assessor (MM/DD/YYYY)