Michigan Department of Treasury
2368 (Rev. 03-16)
ASSESSOR’S DATE STAMP
Principal Residence Exemption (PRE) Affidavit
Issued under authority of Public Act 206 of 1893.
Read the instructions before completing the form. This form is not valid unless certified by the assessor.
Do not submit this form if the property is not your principal Residence and/or any of the disqualifying
factors apply as listed in MCL 211.7(cc).
Type or print in blue or black ink.
PART 1: PROPERTY INFORMATION Type or print legibly. Use a separate form for each property tax identification number.
1. Property Tax Identification Number
2. Name of Local Unit (Check Township or City) 3. County
4. Street Address of Property (Provide a Complete Address)
5. Name of Owner (First, Middle, Last)
6. Owner’s Last Four Digits of Social Security Number
7. Owner’s Daytime Telephone Number
XXX-XX9. Co-Owner’s Last Four Digits of Social Security Number
8. Name of Co-Owner (First, Middle, Last)