Amendment Sheet

Resource Information

Project Number

Historic Property Name if Known (as applicable)

Street Address (address of where property is located, NOT mailing address)

City, Village or Township

County

Zip Code

Name of Historic District or Listed Property

Name of Local Unit of Government

Applicant Information

Applicant First Name

Applicant Last Name

For Co-Owner or for Married Owners: First Name (as applicable)

For Co-Owners or Married Owners: Last Name (as applicable)

Organization Name

Mailing Address

City and State

Zip Code

Phone Number

Email Address

Social Security Number(s) or Tax Payer ID number(s)

For additional Owner: Social Security Number(s) or Tax Payer ID number(s) - as applicable

Project Contact (if different than applicant)

Project Contact First Name

Project Contact Last Name

Project Contact Organization Name

Street Address

City

Zip Code

Phone number

Email

Description of Changes

Application Certification

You must be able to answer "yes" to the question below to submit your application.

I hereby attest that the information I have provided is, to the best of my knowledge, correct. I further attest that I am a Qualified taxpayer as set forth in subsection 266(a)(16)(j) or subsection 676(16)(j) of PA 343 of 2020 Yes

As your signature, please type your full name.

For additional owner: As your signature, please type your full name. (As applicable)

Please note: You have reached the end of the applicant enter data portion of the application. To submit your data please click "submit" below. Following submittal, you will receive an email from The SHPO that details the additional information required to be submitted. This may include images/photos, spec drawings or other documents, as well as proper payment. Once you receive that email, you will have 48 hours to submit the rest of the required information. An application is not considered complete until all required information is submitted.

SHPO State Tax Credit: Amendment Sheet

SHPO Historic Tax Credit Amendment Sheet

Resource Information

Applicant Information

Project Contact (if different than applicant)

Application Certification