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Gaylord, MI 49735

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REQUEST TO RESCIND HOME OWNERS PRINCIPAL RESIDENCE EXEMPTION

Michigan Department of Treasury 2602 (Rev. 1-04)
Issued under authority of Public Act 267 of 1994.

* Denotes required field

1. Property Tax Identification Number
2. Zip Code
3. Street Address of Property
4. Name of Township or City
5. Is this a township or a city?
6. County
	Name of Owner
7a. Owner First Name
7b. Owner Middle Name
7c. Owner Last Name
8. Owners Social Security Number
9a. Co-Owner First Name
9b. Co-Owner Middle Name
9c. Co-Owner Last Name
10. Co-Owners Social Security Number
11. Property Owners daytime phone number
12. I am rescinding this property because
I am no longer the owner of the property I own the property, but I no longer occupy the property as my principal residence I have converted the property to rental property I have converted the property to commercial property
13. If the portion of property in line 1 that you own and occupy as your principal residence has changed, enter the new percentage here
14. Effective date of the changed listed in either 11 or 12	/ /
15. This rescission applies to
16a. New Owners Name
16b. New Co-Owners Name
* Email
* I certify under penalty of perjury the information contained on this document is true and correct to the best of my knowledge	Yes
	*Enter the letters you see