Form 4497 - Ifta Fuel Tax Payment/proposed Adjustments Coupon - 2007
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1Instructions: This form is to be used for payment of an electronically filed IFTA tax report or for
payment of an adjustment to your report that was initiated by the Department of Treasury. If you are
paying on a proposed adjustment, include a copy of the letter to which your payment applies. You
must use a separate coupon for each payment, however you may write one check. If you have any
questions concerning this form please call the Customer Contact Division, IFTA Section at (517)
636-4580.
Detach here and mail in coupon only
Michigan Department of Treasury
4497 (8-07)
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IFTA Fuel Tax Payment/Proposed Adjustments Coupon
Issued under P.A. 119 of 1980, as amended.
CHECK BOX THAT APPLIES
Payment is for a proposed adjustment for the file period _________________________
(mm/yy)
Payment is for an original electronically filed IFTA tax report for the file period _________________
(mm/yy)
IFTA Account Number
Business Name
Office Use Only
Payment Enclosed
Make checks payable to “State of Michigan” and mail with this coupon to:
Michigan Department of Treasury; P.O. Box 77692; Detroit, MI 48277-0692
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Parent category: Financial