Form 4689 State Tax Commission Request for Changes in Personal or Employment Information for a Certified Assessor - Michigan

Form 4689 or the "State Tax Commission Request For Changes In Personal Or Employment Information For A Certified Assessor" is a form issued by the Michigan Department of Treasury.

Download a PDF version of the Form 4689 down below or find it on the Michigan Department of Treasury Forms website.

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Michigan Department of Treasury
4689 (Rev. 08-18)
State Tax Commission Request for Changes in Personal or Employment
Information for a Certified Assessor
In order for the State Tax Commission to maintain accurate records, all certified assessing officers are required to inform the State Tax
Commission in writing of any changes to their personal or employment contact information within 30 days of assumption of duty or the
departure from duty. To request changes to your personal or employment information, complete the appropriate area(s) of this form and
return it by e-mail to the State Tax Commission at
State-Tax-Commission@michigan.gov.
The form may also be mailed to:
State Tax Commission
PO Box 30471
Lansing MI 48909
PArt 1: Assessor
Assessing Officer Name
Certificate Number
Certification Level
R-
PArt 2: PersoNAL INForMAtIoN
This information will be used to receive State Tax Commission personal mailings (e.g., renewal applications, certificates, etc.). You
may request to receive personal mailings at a home or an employment address. This information may be distributed to the public
unless it is requested to remain confidential. Driver’s license numbers are automatically kept confidential.
Check to request personal information be maintained as confidential.
Address (work or home address where personal mailings are to be sent)
Home
Work
City
State
ZIP Code
Home Telephone Number
E-mail Address
Name Change (appropriate documentation must be provided – e.g., marriage license, etc.)
Signature (required)
Date
PArt 3: eMPLoYMeNt INForMAtIoN
This information will be used for official State mailings (STC Bulletins, assessor and/or equalization director correspondence,
electronic notifications, etc.). This information will also be distributed to the public as official local unit assessor and county
equalization director contact information.
New Assessor of Record
New Director of Record
No longer the Assessor/Director of Record
Change of Address Only
(Please provide township information below.)
Address (work address where official State mailings are to be sent)
City
State
ZIP Code
Work Telephone Number
Work E-mail address (required)
Official Title or Position of Employment
Local Unit of Government Name
County
Signature (required)
Date
Reset Form
Michigan Department of Treasury
4689 (Rev. 08-18)
State Tax Commission Request for Changes in Personal or Employment
Information for a Certified Assessor
In order for the State Tax Commission to maintain accurate records, all certified assessing officers are required to inform the State Tax
Commission in writing of any changes to their personal or employment contact information within 30 days of assumption of duty or the
departure from duty. To request changes to your personal or employment information, complete the appropriate area(s) of this form and
return it by e-mail to the State Tax Commission at
State-Tax-Commission@michigan.gov.
The form may also be mailed to:
State Tax Commission
PO Box 30471
Lansing MI 48909
PArt 1: Assessor
Assessing Officer Name
Certificate Number
Certification Level
R-
PArt 2: PersoNAL INForMAtIoN
This information will be used to receive State Tax Commission personal mailings (e.g., renewal applications, certificates, etc.). You
may request to receive personal mailings at a home or an employment address. This information may be distributed to the public
unless it is requested to remain confidential. Driver’s license numbers are automatically kept confidential.
Check to request personal information be maintained as confidential.
Address (work or home address where personal mailings are to be sent)
Home
Work
City
State
ZIP Code
Home Telephone Number
E-mail Address
Name Change (appropriate documentation must be provided – e.g., marriage license, etc.)
Signature (required)
Date
PArt 3: eMPLoYMeNt INForMAtIoN
This information will be used for official State mailings (STC Bulletins, assessor and/or equalization director correspondence,
electronic notifications, etc.). This information will also be distributed to the public as official local unit assessor and county
equalization director contact information.
New Assessor of Record
New Director of Record
No longer the Assessor/Director of Record
Change of Address Only
(Please provide township information below.)
Address (work address where official State mailings are to be sent)
City
State
ZIP Code
Work Telephone Number
Work E-mail address (required)
Official Title or Position of Employment
Local Unit of Government Name
County
Signature (required)
Date

Download Form 4689 State Tax Commission Request for Changes in Personal or Employment Information for a Certified Assessor - Michigan

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