Form 3693 - Single Business Tax Brownfield Redevelopment Credit Assignment
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2Reset Form
Check this box if you are amending to
Michigan Department of Treasury
3693 (Rev. 11-01)
identify a previously unknown lessee.
Single Business Tax
Brownfield Redevelopment Credit Assignment
PART 1 ASSIGNOR IDENTIFICATION
1. Assignor/Qualified Taxpayer Name
2. Tax Year End
3. Account No. (FEIN or TR No.)
Street Address
4. Project Number
5. Date Certificate of Completion Issued
City, State, ZIP
6. Organization Type (check one)
Individual
Fiduciary
Professional Corporation
S-Corporation
Other Corporation
Partnership/LLC-Partnership
LLC-Corporation
PART 2 CREDIT TO BE ASSIGNED
$
.00
7. Enter the amount of approved credit for the above assignor
7.
If you are assigning all or part of your credit to a lessee(s) go to Part 3. If you are assigning all or part of your credit to a
partner, member or shareholder, go to Part 4. All assignors must complete parts 5 and 6 on Page 2.
PART 3 ASSIGNING THE CREDIT TO LESSEE(S)
8. Enter the information below for lessee(s) receiving an assigned credit. If a lessee is unknown at this time check this
box.
Enter "Unknown" in Column B and complete Columns D and E.
A.
B.
C.
D.
E.
Assigned Credit
(multiply line 7 by
Assignee
Date
% of Credit
Column D. Enter here
Account Number
Assignee
Assignee's Tax
to be
and on form C-8000MC,
(FEIN or TR)
Name
Year Ends
Assigned
for each assignee)
a.
b.
c.
d.
e.
f.
g.
h.
%
$
9. Total Columns D and E and enter here
Continued on Page 2.
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