Facsimile Signature Declaration For Personal Property Statement(S) Form printable pdf download

Facsimile Signature Declaration For Personal Property Statement(S) Form

Michigan Department of Treasury

2995 (Rev. 7-01)

Facsimile Signature Declaration

for Personal Property Statement(s)

Public Act 126 of 1996 states that a facsimile signature may be used on a personal property statement if the person

using the facsimile signature has filed this declaration with the State Tax Commission for each year that the facsimile

signature is used. A facsimile signature is a copy or a reproduction of an original signature.

For a facsimile signature to be used on a personal property statement, a completed, notarized, declaration must

be received by the StateTax Commission staff of the Michigan Department of Treasury (517 373-0500) by February

1 of the year of the personal property statement. This declaration must be timely filed every year that a facsimile

signature is to be used on a personal property statement.

PLACE THE FACSIMILE SIGNATURE ON THE LINE BELOW.

(Do not place an actual signature on this line.)

_______________________________________________________

State of ___________________________

County of __________________________

I, ____________________________________________, being duly sworn, depose and say that each personal property

statement containing the facsimile signature printed above is a true and correct statement of all tangible personal

property owned or held by ___________________________________ in the assessing district for which the statement

is made, on the THIRTY-FIRST (31st) DAY OF DECEMBER immediately preceding the year of the personal property

statement(s).

Required Notarization

Must be signed by owner, partner or corporate

officer or a duly authorized agent.

Subscribed and sworn to before me this ______ day

Signed ________________________________

of _________________________, __________

(Actual Signature)

Title __________________________________

______________________________________

Signature of Notary Public

Company Name and Address (City, State, ZIP)

My Commission Expires __________________

_____________________________________

Mail the ORIGINAL Declaration to:

_____________________________________

Michigan State Tax Commission

P.O. Box 30471

Telephone No. (

)

Lansing, MI 48909-7971

Facsimile Signature Declaration For Personal Property Statement(S) Form