Request to Rescind Homeowners Principal Residence Exemption

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

1. Property Tax Identification Number
2. Zip Code
ZIP Code
3. Street Address of Property
Street Address
4. Name of Township or City
City
5. Is this a township or city?
6. County
Name of Owner
7a. Owner First Name
First
7b. Owner Middle Name
Middle
7c. Owner Last Name
Last
8. Owner's Social Security Number
9a. Co-Owner First Name
First
9b. Co-Owner Middle Name
Middle
9c. Co-Owner Last Name
Last
10. Co-Owner's Social Security Number
11. Property Owner's Daytime Phone Number
12. I am resciding 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
First Last
16b. New Co-Owners Name
First Last
Email*
Enter Email Confirm Email
I certify under penalty of perjury the information contained on this document is true and correct to the best of my knowledge*
- Yes
Name
This field is for validation purposes and should be left unchanged.

Name of Owner