Form 3855 - Michigan Tax Amnesty - 2001 Page 2
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1
2Michigan Department of Treasury
4
1. Social Security Number
3874 (12-01)
Michigan Tax Amnesty
4
2. Federal Employer Identification Number (FEIN)
Supplemental Schedule
Complete this schedule if there was not enough space for you to enter all of your return/payment information
on page 1, Part 2 of Form 3855, Michigan Tax Amnesty. Remember to carry the total amount from this
schedule to Form 3855.
PART 2 (Continued)
Taxable Period
C
X
Type
Assessment
Covered
Amount of
of Tax
Number
(MM/YYYY)
Tax Due
Interest
Total
4
4
4
4
4
4
4
4
3.
4
4
4
4
4
4
4
4
4.
4
4
4
4
4
4
4
4
5.
4
4
4
4
4
4
4
4
6.
4
4
4
4
4
4
4
4
7.
4
4
4
4
4
4
4
4
8.
4
4
4
4
4
4
4
4
9.
4
4
4
4
4
4
4
4
10.
4
4
4
4
4
4
4
4
11.
4
4
4
4
4
4
4
4
12.
4
4
4
4
4
4
4
4
13.
4
4
4
4
4
4
4
4
14.
4
4
4
4
4
4
4
4
15.
4
4
4
4
4
4
4
4
16.
4
4
4
4
4
4
4
4
17.
4
18.
TOTAL AMOUNT ON THIS SCHEDULE.
(ENTER ON PAGE 1, PART 2, LINE 21 OF FORM 3855)
Attach this completed schedule to Form 3855, Michigan Tax Amnesty.
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