Historic Property Name If Known (as applicable)
Street Address
City, Village or Township (address of where property is located, NOT mailing address)
County
Zip Code
Certification that the Resource (check only one)
Name of Historic District or Listed Property
Name of Local Unit of Government
Applicant First Name
Applicant Last Name
For Co-Owner or for Married Owners: First Name (as applicable)
For Co-Owners or for 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 from Applicant)
Project Contact First Name
Project Contact Last Name
Project Contact Organization Name
Street Address
City
Zip Code
Phone number
Email
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.
As your signature, please type your full name.
For additional Owner: As your signature, please type your full name (as applicable).
Description of Physical Appearance
Date of Construction
Sources
Date(s) of additions and/or alterations
For properties that have been previously adaptively reused, what was the use of resource prior to rehabilitation?
Statement of Significance
Declaration of Location Form
All applicants attempting to qualify for the State Tax Credit based on a property’s contribution to a locally designated historic district must submit a completed Declaration of Location form. Because the creation and monitoring of locally designated districts is the sole right and responsibility of the local unit, the SHPO may not have the most up-to-date local designation information. This form allows the owner/applicant and the local unit the opportunity to verify the limits of the district and promotes contact between the resource owner considering undertaking work and the agent of the local unit charged with monitoring aspects of that work. Please download this form here ,
Part 2 - Rehabilitation Plan
Data on Rehabilitation Project
Proposed Use After Rehabilitation
Estimated Qualified Expenses $
Which credits are this project seeking? (Select only 1)
VERIFICATION OF STATE EQUALIZED VALUE (SEV)
If you selected "Small Commercial Credit" or "Large Commercial Credit" above, the SEV form is required and must be completed and uploaded to this application. You can download the SEV form here .
Select the button below if an SEV does not exist for this property. You will be required to submit a property appraisal by a Michigan Certified General Appraiser completed less than two years prior to this application and with the building in generally same condition as it currently exists. (Instructions on uploading an appraisal will be emailed upon receipt of your application.)
Does this Project have an Approved Part 1 State Application? Please note: Part 2 will not be reviewed until a Part 1 Application is Approved.
If Yes, Please Provide Date of Approval
WORK COMPLETED OVER PAST YEAR FOR WHICH CREDITS ARE REQUESTED
Description of Work
Prior Work Completed: Start Date
Prior Work Completed: End Date
I/we certify that all previous work claimed in this application was completed no more than one year prior to this submission date.
Please note: Before and After Photos, Plans and Specs of this work are required for review. More information on this will be provided via email after you submit your application.
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.
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.
Submit
