Form 4567 Draft - Michigan Business Tax Annual Return - 2009 Page 3
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4567, Page 3
FEIN or TR Number
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PART 3: TOTAL MICHIGAN BUSINESS TAX
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51. Total Michigan Business Tax Before Surcharge and Credits. Add lines 27 and 50 ...................................
51.
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52. Annual Surcharge. Enter the lesser of $6,000,000 or line 51 multiplied by 21.99% (0.2199) ...........................
52.
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53. Total Liability Before All Credits. Add lines 51 and 52 ...................................................................................
53.
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54. Nonrefundable credits from Form 4568, line 40 ................................................................................................
54.
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55. Total Tax After Nonrefundable Credits. Subtract line 54 from line 53. If less than zero, enter zero ............
55.
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56. Recapture of Certain Business Tax Credits and Deductions from Form 4587, line 12 ......................................
56.
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57. Total Tax Liability. Add lines 55 and 56 ...........................................................................................................
57.
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PART 4: PAYMENTS, REFUNDABLE CREDITS AND TAX DUE
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58. Overpayment credited from prior MBT return ....................................................................................................
58.
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59. Estimated tax payments ....................................................................................................................................
59.
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60. Tax paid with request for extension ...................................................................................................................
60.
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61. Refundable credits from Form 4574, line 25 .....................................................................................................
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62. Payment and credit total. Add lines 58 through 61. (If not amending, then skip to line 64.) .............................
62.
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a. Payment made with the original return ......................
63a.
AMENDED
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b. Overpayment received on the original return ............
63b.
63.
RETURN
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ONLY
c. Add lines 62 and 63a and subtract line 63b
from the sum.............................................................. ........................................................
63c.
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64. TAX DUE. Subtract line 62 (or line 63c, if amending) from line 57. If less than zero, leave blank ....................
64.
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65. Underpaid estimate penalty and interest from Form 4582, line 38 ....................................................................
65.
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% =
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66. Annual return penalty (a)
(b)
plus interest (c)
. Total ...... 66d.
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67. PAYMENT DUE. If line 64 is blank, go to line 68. Otherwise, add lines 64, 65 and 66d .................................
67.
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PART 5: REFUND OR CREDIT FORWARD
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68.
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Overpayment. Subtract lines 57, 65 and 66d from line 62 (or line 63c, if amending)
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If less th
68.
an zero, leave blank (see instructions) .................................................................................................
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69. CREDIT FORWARD. Amount of overpayment on line 68 to be credited forward .............................................
69.
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70. REFUND. Amount of overpayment on line 68 to be refunded ...........................................................................
70.
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Taxpayer Certification.
Preparer Certification.
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I declare under penalty of perjury that the information in this
I declare under penalty of perjury that this
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return and attachments is true and complete to the best of my knowledge.
return is based on all information of which I have any knowledge.
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Preparer’s PTIN, FEIN or SSN
By checking this box, I authorize Treasury to discuss my return with my preparer.
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Authorized Signature for Tax Matters
Preparer’s Business Name (print or type)
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Authorized Signer’s Name (print or type)
Date
Preparer’s Business Address and Telephone Number (print or type)
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Title
Telephone Number
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Return is due April 30 or on or before the last day of the 4th month after the close of the tax year.
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WITHOUT PAYMENT. Mail return to:
WITH PAYMENT. Pay amount on line 67. Mail check and return to:
Michigan Department of Treasury, P.O. Box 30783, Lansing, MI 48909
Michigan Department of Treasury, P.O. Box 30113, Lansing, MI 48909
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Make check payable to “State of Michigan.” Print taxpayer’s FEIN or TR
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Number, the taxpayer’s name, and “MBT” on the front of the check. Do not
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staple the check to the return.
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+
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