Essential Services Assessment Annual Return

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Michigan Department of Treasury (0-), Page Essential Services Assessment Annual Return Issued under authority of the General Property Tax Act, Public Act of, and the State Essential Services Assessment Act, Public Act of. Retain this copy for your records. Do not mail to the Michigan Department of Treasury. Part : Taxpayer Information Tax Year Taxpayer Name Indicate assumed names used by legal entity (if any) Mailing Address for ESA Correspondence Mailing Address Line Check if amended. City State ZIP Code Country Authorized Representative Name E-mail Address for ESA Correspondence Part : Return summary Authorized Representative Title Telephone Number for ESA Correspondence Federal Employer Identification Number (FEIN) Total ESA Liability reflects the combined liability for every parcel identified in this return. Liability for each property is calculated in Part of this return. A Late Payment Penalty will be assessed on the outstanding balance of an ESA Annual Return not paid by August. The penalty is % per week on the unpaid balance for each week payment is not made in full, up to a maximum of % of the total amount due. The Total Payment Due is the sum of the Total ESA Liability and Late Payment Penalty (if applicable). Total ESA Liability Late Payment Penalty Total Payment Due Part : preparer certification I declare under penalty of perjury that this return is based on all information of which I have any knowledge. Preparer Name Preparer Telephone Number Preparer Business Name FINAL 0-- Preparer FEIN Preparer Date Signed Preparer Street Address City State ZIP Code By checking this box, Treasury is authorized to discuss this return with the preparer. Continue on Page 0 0 0 0 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0, Page Part : ESA Parcel Summary This summary of properties included in the Essential Services Assessment Annual Return (Form ) lists only properties located in the county and local unit named below. The list of properties associated with this county and local unit will continue to an additional page, if necessary. Properties in other counties and local units will also print on separate pages. The ESA liability of all properties on all summary pages will equal the Total ESA Liability listed in Part of Form. County of All Properties Listed on this Page Corrected Parcel Number (Y) P.A. Property (Y) P.A. Property (Y) Local Unit of All Properties Listed on this Page Renaissance Zone Reduction Percentage MSF ESA Resolution Percentage ESA Liability This Property Summary Continues on Additional Pages, If Necessary Continue on Page 0 0 0 0 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0, Page Part : parcel information The information below must be provided for each parcel included in this return. The ESA liability for each parcel is calculated on the following pages. Check if there is zero acquisition cost reported on line a, Columns A-L. Check if the personal property reported on this form includes leased personal property for which the election of lessee report is being filed. The taxpayer must have completed the Election of Lessee Report of Eligible Manufacturing Personal Property (Form ) and included it with the Eligible Manufacturing Personal Property Tax Exemption Claim, Ad Valorem Personal Property Statement, and Report of Fair Market Value of Qualified New and Previously Existing Personal Property (Combined Document) (Form ) when filed with the local tax collecting unit.. County. City a. Township b. Village. Revenue Sharing Code a. b. Correction a. Reason Code for Line Being Zero b. Description. Name of Person in Charge of Records. Telephone Number. Record Location (Street Address, City, State, ZIP Code). Personal Property Location: Street Address City State ZIP Code. List all real property parcel numbers where the personal property reported on this form is located.. Primary Occupant Name a. Renaissance Zone Name b. Expiration Date a. P.A. (MCL.f) New Personal Property Exemption Certificate Number b. Effective/Local Unit Resolution Date c. Expiration Date a. Industrial Facilities Exemption (P.A. of, as amended) Certificate Number b. Effective Date c. Expiration Date a. Michigan Strategic Fund (MSF) ESA Resolution Certificate Number b. Effective Date c. Expiration Date d. Check if 0% Michigan Strategic Fund (MSF) ESA Resolution Complete columns A through K, line only. e. Check if % Michigan Strategic Fund (MSF) ESA Resolution Continue on Page 0 0 0 0 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0, Page Part : parcel information Section The calculation of the ESA liability per parcel begins below for construction in progress (as defined in MCL.m()(c)) and properties placed in service from the years through. Years through are included in Part, Section, and years 0 through 0 and prior are included in Part, Section. The total for this parcel is listed at the end of Section. a. Acquisition Cost when First Placed in Service. If zero, skip the remaining lines in this column and proceed to the next column... a. b. Construction in Progress Acquisition Cost After Reduction. Multiply line a by %... b.. Industrial Facilities Exemption - IFT - (P.A. of, as amended) Acquisition Cost After Reduction. Multiply line a by % if parcel is subject to an extended IFT effective before January,, or if EMPP exempt under MCL.m or.n would have been subject to an IFT effective before January,. (Must have valid certificate number on line a.).... Year Placed in Service A. B. C. D. Construction in Progress (CIP). Millage Rate..... mills. mills. mills. mills. MSF ESA Resolution Millage Rate. If box on line e is checked, use % MSF millage rate..... mills. mills. mills. mills. Tax Before Renaissance Zone Reduction. Multiply line a or line b by line ; or, if parcel qualifies for a reduction on line, multiply line by line ; or if parcel qualifies for a % MSF ESA Resolution, multiply either line a, line b, or line (as applicable) by line..... Renaissance Zone Reduction Percentage. If a Renaissance Zone was entered on line a, enter the Renaissance Zone Reduction Percentage and proceed to line (see Renaissance Zone Reduction Table). All others proceed to line..... Renaissance Zone Reduction. Multiply line by the Renaissance Zone Reduction Percentage on line..... Tax After Renaissance Zone Reduction. If an amount was entered on line, subtract line from line. All others, enter amount from line.... Continue on Page 0 0 0 0 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0, Page Part : parcel information Section a. Acquisition Cost when First Placed in Service. If zero, skip the remaining lines in this column and proceed to the next column... a. b. Construction in Progress Acquisition Cost After Reduction. Multiply line a by %... b.. Industrial Facilities Exemption - IFT - (P.A. of, as amended) Acquisition Cost After Reduction. Multiply line a by % if parcel is subject to an extended IFT effective before January,, or if EMPP exempt under MCL.m or.n would have been subject to an IFT effective before January,. (Must have valid certificate number on line a.).... Year Placed in Service E. F. G. H.. Millage Rate..... mills. mills. mills. mills. MSF ESA Resolution Millage Rate. If box on line e is checked, use % MSF millage rate..... mills. mills 0. mills 0. mills. Tax Before Renaissance Zone Reduction. Multiply line a or line b by line ; or, if parcel qualifies for a reduction on line, multiply line by line ; or if parcel qualifies for a % MSF ESA Resolution, multiply either line a, line b, or line (as applicable) by line..... Renaissance Zone Reduction Percentage. If a Renaissance Zone was entered on line a, enter the Renaissance Zone Reduction Percentage and proceed to line (see Renaissance Zone Reduction Table). All others proceed to line..... Renaissance Zone Reduction. Multiply line by the Renaissance Zone Reduction Percentage on line..... Tax After Renaissance Zone Reduction. If an amount was entered on line, subtract line from line. All others, enter amount from line.... Continue on Page 0 0 0 0 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0, Page Part : parcel information Section a. Acquisition Cost when First Placed in Service. If zero, skip the remaining lines in this column and proceed to the next column... a. b. Construction in Progress Acquisition Cost After Reduction. Multiply line a by %... b.. Industrial Facilities Exemption - IFT - (P.A. of, as amended) Acquisition Cost After Reduction. Multiply line a by % if parcel is subject to an extended IFT effective before January,, or if EMPP exempt under MCL.m or.n would have been subject to an IFT effective before January,. (Must have valid certificate number on line a.).... Year Placed in Service I. J. K. L. 0 0 0 0 and prior. Millage Rate..... mills. mills. mills 0. mills. MSF ESA Resolution Millage Rate. If box on line e is checked, use % MSF millage rate.... 0. mills 0. mills 0. mills 0. mills. Tax Before Renaissance Zone Reduction. Multiply line a or line b by line ; or, if parcel qualifies for a reduction on line, multiply line by line ; or if parcel qualifies for a % MSF ESA Resolution, multiply either line a, line b, or line (as applicable) by line..... Renaissance Zone Reduction Percentage. If a Renaissance Zone was entered on line a, enter the Renaissance Zone Reduction Percentage and proceed to line (see Renaissance Zone Reduction Table). All others proceed to line..... Renaissance Zone Reduction. Multiply line by the Renaissance Zone Reduction Percentage on line..... Tax After Renaissance Zone Reduction. If an amount was entered on line, subtract line from line. All others, enter amount from line..... Total ESA Liability for Parcel. Add line, column A through column L.... 0 0 0 0 0 0 0 0 0 0 0 0 0