Hardship
Exemption Application
I, _____________________________, being the owner and resident of the property listed below, apply for tax relief under MCL 211.7u of the General Property Tax Act. The real and personal property of persons who, in the judgment of the Supervisor and Board of Review, by reason of poverty are unable to contribute toward the public charges are eligible for exemption in whole or in part from taxation under this act.
Property Code Number: 58 -10-___________________________
Property Address: _________________________________________________________________________
Age of applicant: ________________ Marital Status: ___________________________
Phone number: _________________________ Age of Spouse: ____________________________
Number of dependants: _________________ Age(s) of dependants: _______________________
Have you applied for Homestead Property Tax Credit this year? ____________________
How much was your Property Tax Credit Refund? _______________________________
**Attach a copy of 1040CR and Federal or
State Income Tax Return for EACH person residing in the Home.**
REAL ESTATE: Is home paid for? ___________ Unpaid Balance: ________________________________
Name of Mortgage Company: _______________________________________________________________
Monthly Payment: ____________________ How long have you lived at this residence?___________
Do you own or are you buying any other property? ______________________________________________
Property Address Assessed Value Amount and Date of last
taxes paid
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Income earned from above property: $_____________________________________
INCOME:
Name of Employer: ____________________________________________________
Address: ______________________________________________________________
Work Phone: ( )_____________________________________________________
List all income from salaries, Social Security, rents, pensions, unemployment compensation, disability,
government pensions, workers compensation, dividends, claims and judgments from lawsuits, alimony,
child support and any other source.
Source of Income Monthly Income Annual Income
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