Michigan Department of Treasury
5618 (07-18)
Request to Rescind the Small Business Property Tax Exemption Claim
Under MCL 211.9o
A person claiming an exemption under MCL 211.9o shall rescind the claim of exemption by February 20th of the year in which the personal
property is no longer eligible for the exemption, by ling this form along with a personal property statement (Form 632) with the assessor
of the local unit (City or Township) where the personal property is located.
An owner who fails to le a rescission and whose property is later discovered to be ineligible for the exemption is subject to repayment
of any additional taxes with interest at a rate of 1% per month or fraction of a month and penalties compute from the date the taxes were
last payable without interest or penalty.
General Information
Name and Mailing Address of Owner(s) or Partners (if sole proprietorship or partnership) - attach a separate sheet if necessary
Name of Local Unit of Government
City:______________________ Township:______________________ Village:______________________
County Where the Property is Located
Parcel Number Assumed Name(s) Used by Legal Entity (if any) Owner Telephone Number
Year the original Form 5076 was led with the City or Township
Name, Telephone Number and Email Address of the Person in Charge of Personal Property Records Address Where Personal Property Records are Kept
Certication
1. I certify that I am the owner of the eligible personal property or I am the duly authorized agent (must attach a letter of authority).
2. I certify that the personal property that was previously claimed on Form 5076 is no longer eligible for the Small Business Taxpayer Exemption, as dened in MCL 211.9o and
I am requesting that the exemption be rescinded.
Printed Name Title Date
Signature
