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Michigan Department of Treasury                                                      Parcel Number 
5076 (Rev. 07-21) 
                                                                                                                                                                   2022 

Small Business Property Tax Exemption Claim Under MCL 211.9o 
This form is to be filed with the local unit (City or Township) where the personal property is located. Please contact the local unit where 
the personal property is located for their mailing address. This form IS NOT to be mailed to the Michigan Department of Treasury or 
Michigan State Tax Commission. This form                 must be filed no later than February 22, 2022 (postmark is acceptable).                                 Late filed forms 
may be filed directly with the 2022 March Board of Review prior to the closure of the March Board. 
This form must be filled out in it’s entirety. Failure to fill out the form completely can be cause for denial of the exemption. Taxpayers should 
pay particular attention to including contact information, including phone number and email address. 
General Information 
 Business Name 

 Name and Mailing Address of Owner(s) or Partners (if sole proprietorship or partnership) - attach a separate sheet if necessary 

 Name of Local Unit of Government                                                                                      County Where the Property is Located 
 City:______________________ Township:______________________ Village:______________________ 
 Parcel Number                                                 Assumed Name(s) Used by Legal Entity (if any)           Owner Telephone Number 

 Date Business Began in Local Tax Collecting Unit              Description of Owner’s Business Activity 

 Name, Telephone Number and Email Address of the Person in Charge of Personal Property Records                         Address Where Personal Property Records are Kept 

 Names of all other businesses having personal property, including any leasehold improvements assessed as personal property at the location(s) included in this form. 
 (Attach additional sheets as necessary.) 

 List all addresses where any personal property owned by, leased to, or in the possession of the owner listed above or a related entity is located within the local tax collecting 
 unit. (Attach additional sheets as necessary.) 

The undersigned certifies that: 
1.   I am the owner of the commercial personal property and/or industrial personal property being claimed as exempt or I am the duly authorized agent. 
2.     The True Cash Value of all the Personal Property, as defined by MCL  211.9o located within the local tax collecting unit indicated above, that is owned by, leased to, or in the 
     possession of the owner or related entity was less than $80,000 on December 31, 2021. 
3.   The following procedures were used to determine that the True Cash Value of the Eligible Personal Property was less than $80,000 on December 31, 2021:         
     a)     The determination of True Cash Value was based on the State Tax Commission’s recommended valuation procedures as set forth on Form 632 (L-4175),              Personal 
         Property Statement. 
     b)     The determination of True Cash Value includes all assessable personal property, located within the city or township listed on this form that is owned by, leased to, or 
         in the possession of the owner or related entity. This shall include all trade fixtures and may include leasehold improvements not assessed as real property. Attach an 
         explanation if not all personal property is included. 
4.     I understand that according to MCL 211.9o, I am required to maintain and provide access to books and records for audit purposes as provided in section 22. 
5.     All of the information contained within Form 5076 is true and accurate and to the best of my knowledge and belief, and I acknowledge a fraudulent claim for exemption under 
     MCL 211.9o is subject to the penalties as provided for in section 21(2). 
 Printed Name                                                          Title                                                              Date 

 Signature 

                                                                                                                                       LOCAL UNIT USE ONLY 
                                                                                                                       Date Received 

5076, Page 2 

              Instructions for Small Business Property Tax Exemption Claim Under  
                                                    MCL 211.9o (Form 5076) 
MCL 211.9o provides for a personal property tax exemption for “eligible personal property”. This is commonly referred to as the 
Small Business Taxpayer Exemption. MCL 211.9o defines “eligible personal property” as meeting all of the following criteria: 

The       • personal property must be classified as industrial personal property or commercial personal property as defined in MCL     211.34c 
or would be classified as industrial personal property or commercial personal property if not exempt and 
       • The combined true cash value of all industrial personal property and commercial personal property owned by, leased by or in the 
possession of the owner or a related entity claiming the exemption is less than $80,000 in the local tax collecting unit and 
       • The property is not leased to or used by a person that previously owned the property or a person that, directly or indirectly controls, 
is controlled by, or under common control with the person that previously owned the property. 

In order to claim this exemption, this form      must be filed with the local unit (City or      Township) where the personal property is 
located no later than   February 22, 2022     (postmark is acceptable)  . This form IS NOT to be mailed to the Michigan Department of 
Treasury or the Michigan State Tax Commission.        Please contact the local unit where the personal property is located for         their      
mailing address.  Late filed forms may be filed directly with the local unit March Board of Review prior to the closure of the March 
Board of Review. Taxpayers must contact the local unit directly to determine the March Board of Review dates. 

Taxpayers must appear in person or have a representative appear on their behalf in order to late file with the March Board of Review. 

Once  the  exemption  is  granted,  the  taxpayer     will  continue  to  receive  the  exemption  until  they  no  longer   qualify  for    the 
exemption. Once they no longer          qualify, the taxpayer    is required to file a rescission form and a personal property statement 
no later  than February 20th of the year        that the property is no longer     eligible. Failure to file the rescission form will result in 
significant penalty and interest as prescribed by P.A. 132 of 2018: “An owner            who fails to file a rescission and whose property 
is later  discovered to be ineligible for   the exemption is subject to repayment of any additional taxes with interest at a rate of 
1% per        month or  fraction of a month and penalties computed from the date the taxes were last payable without interest or                  
penalty.” 

This form will exempt property owned only by the entity filing the form. If personal property is leased to or used by an entity  other 
than the property’s owner, the owner of that personal property must file the form for that property, not the lessee or the user. The 
owner may file the form and claim the exemption only if the True Cash Value of all of the commercial or industrial personal property 
located within the local tax collecting unit that is owned by, leased to, or in the possession of the owner or a related entity was less 
than $80,000 on December 31, 2021. 

This form must be filled out in it’s entirety. Failure to fill out the form completely can be cause for denial of the exemption. Taxpayers 
should pay particular attention to including contact information, including phone number and email address. 

Taxpayers who file Form 5076 are not required to file a          Personal Property Statement  (Form 632) in the year they are claiming the 
exemption. 

NOTICE:       Questions  regarding  this  form  should  be  directed  to  the  assessor  of  the  city  or  township  where  the  personal  property 
is  located.  This  form  is  issued  under  the  authority  of  Public  Act  206  of  1893.  Additional  detailed  information  on  the  Small 
Business  Taxpayer  Personal Property Exemption  can  be found on the  State  Tax Commission  Web site  at              www.michigan.gov/ 
statetaxcommission.