Principal Residence Exemption (pre) Affidavit

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Michigan Department of Treasury
2368 (Rev. 11-17)
ASSESSOR’S DATE STAMP
Principal Residence Exemption (PRE) Affidavit
Issued under authority of Public Act 206 of 1893.
Read the instructions before completing the form. This form is not valid unless certified by the assessor.
Do not submit this form if the property is not your principal residence and/or any of the disqualifying factors
apply as listed in MCL 211.7(cc). For information regarding the PRE, please review the PRE Guidelines at
Type or print in blue or black ink.
PART 1: PROPERTY INFORMATION
Type or print legibly. Use a separate form for each property tax identification number.
1. Property Tax Identification Number
2. Name of Local Unit (Check Township or City) 3. County
Township
City
4. Street Address of Property (Provide a Complete Address)
5. Name of Owner (First, Middle, Last)
6. Owner’s Last Four Digits of Social Security Number
7. Owner’s Daytime Telephone Number
XXX-XX-
8. Name of Co-Owner (First, Middle, Last)
9. Co-Owner’s Last Four Digits of Social Security Number
10. Co-Owner’s Daytime Telephone Number
XXX-XX-
11. Date you owned and occupied the property in line 1 ............................................................................................... 11.
Month
Day
Year
The property in line 1 above is my:
11a.
Principal residence
11b.
Unoccupied adjoining or contiguous property that is classified residential or timber-cutover.
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. Please consult with your
local assessor to determine the percentage of the exemption the owner is allowed to claim in these situations.. ...... 12.
%
13. Have you claimed a principal residence exemption for another Michigan principal residence? ............................... 13.
Yes
No
14. If yes to 13, enter the property address and parcel number:
15. If yes to 13, have you rescinded that principal residence exemption? ...................................................................... 15.
Yes
No
16. Do you or your spouse claim a similar exemption, credit or deduction on property located in another state? .......... 16.
Yes
No
17. If yes to 16, enter the property address and parcel number:
18. Have you or your spouse filed a tax return as a non-resident of Michigan or resident of another state? ................ 18.
Yes
No
19. If yes to 18, enter the state:
PART 2: CERTIFICATION
Certification: I certify under penalty of perjury that I own and occupy as a principal residence on the date stated in Line 11 and that I have not claimed
a substantially similar exemption/deduction/credit in property in another state, and that the information contained on this document is true and correct
to the best of my knowledge.
20. Owner’s Signature
Date
21. Co-Owner’s Signature
Date
22. Mailing Address, if Different than Property Address Above
LOCAL GOVERNMENT USE ONLY (do not write below this line)
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?
Approved
Denied (Attach a copy of the Local Unit Denial)
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)
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