Michigan Department of Treasury
471 (Rev. 03-12)
Application for Deferment of Summer Taxes
Issued under the authority of Public Act 206 of 1893; MCL 211.51
INSTRUCTIONS: File this application with the treasurer of your city, village, or township. You may le your intent to defer before
September 15, or before the date your summer taxes are due, whichever is later.
Department of Treasury.
NOTE: Though ling this form is voluntary, your tax due date will not be extended unless this form is led. The local treasurer may
require additional documentation to verify your claim.
Last Name First Name M.I.
Telephone Number Property Identication Number
Address of Principal Residence (street number and name, city, state, ZIP code) Name of City, Township, or Village (taxing authority)
City Township Village
I hereby request that the Treasurer of the above-noted municipality defer the due date of the summer taxes on the property identied
above, without penalty or interest charges, until February 15 (payment must be received on or before February 14 to avoid penalty
and interest) based on the following qualication:
(Check 1 or 2 below to identify your basis for this application. Select one choice only.)
1.
Principal Residence:
I certify that my gross household income for the preceding calendar year did not exceed $40,000 and that I qualify for
the deferment provided for in the General Property Tax Act under the classication marked below:
62 years of age or older, including the unmarried surviving spouse of a person who was 62 years of age or older
at the time of death
Paraplegic, Hemiplegic, or Quadriplegic
Eligible Serviceperson, Eligible Veteran, Eligible Widow or Widower
Blind Person
Totally and Permanently Disabled
2.
I certify that I own the above property, which is classied or used as agricultural real property, and that the gross
receipts of agricultural or horticultural operations in the previous year (or the average gross receipts for such
operations in the previous three years) are not less that my household income for the preceding calendar year or the
combined household incomes in the previous year of the individual members of a limited liability company or partners
of a partnership that owns the agricultural real property.
PART 3: CERTIFICATION
I understand that if this deferment is approved, the deferred taxes must be paid on or before February 14 in order to avoid penalty and interest.
I also understand that misleading or false statements on this application may subject me to penalties and interest for late payments of taxes.
Applicant’s Signature Date
FOR CITY, VILLAGE, OR TOWNSHIP USE ONLY
Deferment Approval Signature Date
