Form 2704a - Application For Neighborhood Enterprise Zone Certificate
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Michigan Department of Treasury
STC Use Only
2704A (Rev. 5-07)
Application No.
Date Received
Application for Neighborhood Enterprise Zone
Certificate
Issued under authority of Public Act 147 of 1992, as amended.
Instructions: Read the instructions before completing the application. This application must be filed prior to building permit
issuance and start of construction. Initially file one original application (with legal description) and two additional copies of this
form with the clerk of the local governmental unit (three complete sets). The additional documents to complete the application process
will be required by the State of Michigan only after the original application is filed with the clerk of the local governmental unit (LGU).
This form is also used to file a request for the transfer of an existing NEZ certificate. Please see the instruction sheet.
TO BE COMPLETED BY CLERK OF LOCAL GOVERNMENT UNIT (LGU)
Signature of Clerk
Date received by LGU
LGU Application Number
LGU Code
Part 1: Owner/Applicant Information (complete all fields)
Amount of years requested for
Applicant Name
exemption
Location of Facility (Street No., City, State, ZIP Code)
County
City of
Township of
Village of
School District where facility is
Application is
School Code
located
New
Rehabilitation
Transfer (1 copy only)
Is the building owned or rented by the occupants?
Type of Property
House
Duplex
Condo
Owned
Rented
Loft
Apartment – No. of Units __
Name of LGU that established district
Name or Number of Neighborhood Enterprise Zone
Date district was established
Identify who the work was completed by
Estimated Project Cost (per unit)
Licensed Contractor
Other ________________________
Describe the general nature and extent of the rehabilitation or new construction to be undertaken. Include Breakdown of Investment Cost (use
attachments if necessary)
Timetable for undertaking and completing the rehabilitation or construction of the facility.
Part 2: Applicant Certification
I certify the information contained herein and in the attachments are true and that all are truly descriptive of the residential real
property for which this application is being submitted.
I certify I am familiar with the provisions of Public Act 147 of 1992, as amended, (MCL 207.771 to 207.787) and to the best of my
knowledge, I have complied or will be able to comply with all of the requirements thereof which are prerequisite to the approval of the
application by the LGU and the issuance of Neighborhood Enterprise Zone Certificate by the State Tax Commission.
Contact Telephone Number
Contact Name
Contact Fax Number
Contact E-mail Address
Owner/Applicant Name
Owner/Applicant Telephone Number
Owner/Applicant Signature
Date
Owner/Applicant E-mail Address
Owner/Applicant Mailing Address (Street No., City, State, ZIP Code)
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Parent category: Financial