Form C-3359 - Conditional Tax Clearance Request
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1Michigan Department of Treasury
514, Formerly C-3359 (Rev. 4-00)
Date
CONDITIONAL TAX CLEARANCE REQUEST
IMPORTANT: This is a request for a Michigan Conditional Tax Clearance by a Sole-Proprietorship, or Corporation which has sold
substantially all of it's assets, but the corporate shell will remain to continue filing Michigan tax returns when due until the
corporation later determines whether it will file a Certificate of Dissolution with the Corporation Division. A business requesting a
Michigan Conditional Tax Clearance should forward all UNFILED Michigan Tax returns (up to date of discontinuance) together with
all remittances for those returns, to the attention of the COLLECTION DIVISION, TAX CLEARANCE SECTION. Returns and
remittances not addressed to the TAX CLEARANCE SECTION will enter the regular mail stream and do not become available for
our inspection until several months after mailing. Please complete all parts of this form and then send it to: Michigan Department of
Treasury, Treasury Building, Lansing, Michigan 48922. Attention: TAX CLEARANCE SECTION.
This form is issued under the provision of P.A. 144 of 1921, as amended (Revenue Act); P.A. 265 of 1947, as amended (Cigarette
Tax Act); P.A. 281 of 1967, as amended (Michigan Income Tax Act); P.A. 119 of 1980, as amended (Motor Carrier Tax Act); P.A.
167 of 1933, as amended (Sales Tax Act); and P.A. 94 of 1937, as amended (Use Tax Act). Filing of this form is voluntary. A
conditional tax clearance certificate will not be issued without it.
1. FE or TR Number
Social Security Number(s)
2. Owner(s) Name(s) (Individuals and Partnerships)
3. Doing Business As: (Trade Name)
4. Business Address (No. and Street, City, State, ZIP)
6. Date Business Started at This Location
5. If a Corporation, Date Incorporated in Michigan
8. Ending Date of Last Payroll at This Location
7. Date Business Discontinued at This Location
9. Are You Continuing Business Activity After Clearance?
NO
YES: EXPECTED GROSS RECEIPTS FOR THE YEAR . . . $
Residence Area Code and Phone No.
10. Residence Address of Discontinued Taxpayer
If Multiple Locations, is Clearance Wanted Only For
11. Does Taxpayer Operate More Than One Place of Business?
YES
NO
YES
NO
The Above Location?
12. Names and Addresses of Business Locations Still in Operation (Use reverse side if more space is needed)
13. Are You Selling or Disposing of Business to Another Person?
NO
YES DATE:
14. Name and Address of Purchaser
15. Purchaser's FE or TR No.
16. Is Money Being Held in Escrow Pending Receipt of a Tax Clearance?
NO
YES: AMOUNT . . . $
17. Business Name and Address of Holder of Escrow Money
Holder's Area Code and Phone No.
18. Attention of
19. Month(s) Included on Final Federal 941 Return
Holder's Area Code and Phone No.
20. Name and Location of Holder of Seller's Books and Records
21. Remarks
I declare under penalty of perjury that I am the owner, or
22.
Signature
Date
authorized representative of the business on which tax
clearance is requested, and that the information is true.
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