Michigan Department of Treasury and MESA
1. Federal Employer Identification Number (Required for MESA)
518 (Rev. 9-97). Formerly C-3400.
If you do not have an FEIN, call the IRS at 1-800-829-1040.
REGISTRATION FOR MICHIGAN TAXES
2. Complete Company Name or Owner's Full Name (include, if applicable, Corp., Inc., P.C., L.C., L.L.C., L.L.P., etc.)
3. Business Name, Assumed Name or DBA (as registered with the county)
4A. This address is for all legal contacts. Enter number and street (no P.O. boxes).
Business Telephone
Legal
City, State, ZIP
County
Address
4B. This address is where all tax forms will be sent unless otherwise instructed.
If this address is for an accountant,
bookkeeper or other representative,
Mailing
attach a Power of Attorney.
City, State, ZIP
Address
4C. This address is the actual location of the business in Michigan. Enter number and street (cannot be a P.O. box number).
Physical
City, State, ZIP
County
Address
5. Type of Business Ownership (check one only)
(1) Individual (Sole Proprietorship)
(4) Michigan Corporation
(6) Trust or Estate (Fiduciary)
(2) Husband/Wife
(7) Joint Stock Club or Investment Co.
(1) Subchapter S
(3) Partnership
(8) Social Club or Fraternal Org.
(2) Professional
(3) Registered Partnership, Agreement Date:
(9) Other (Explain)
(3) Limited Partnership - Identify all general partners below.
(5) Non-Mich. Corporation
(34) Limited Liability Co. or Partnership
(1) Subchapter S
Domestic (Mich)
Date of Incorporation
State of Incorporation
Michigan Department of Consumer &
Industry Services Identification No.
Professional
Mo.
Day
Year
Foreign (Non-Mich)
6. Which taxes do you expect to owe?
What date will that liability begin?
How much of each tax do you estimate you will owe each month?
Sales Tax
Up to $65
Up to $300
Over $300
Mo.
Day
Year
Use Tax
Up to $65
Up to $300
Over $300
Mo.
Day
Year
Income Tax Withholding
Up to $65
Up to $300
Over $300
Mo.
Day
Year
How many people will you employ who are
Single Business Tax
subject to Michigan withholding?
Mo.
Day
Year
Motor Fuel Taxes
Treasury will review your registration and send you any necessary tax application forms.
Tobacco Products Tax
Treasury will review your registration and send you any necessary tax application forms.
MESA Unemployment Tax
MESA will determine your liability date and tax rate. Enclose Articles of Incorporation or Organization.
7. Estimated annual Michigan gross receipts?
GROSS RECEIPTS are from (a) sales of inventory items, (b) rental or leases, (c) performance
Up to $250,000
Over $250,000
of services, interest, royalties, etc., to the extent they are derived from business activity.
8A. Name (Last, First, Middle, Jr./Sr./III)
Social Security Number
Title
Date of Birth
Residence Address (Number, Street)
Driver License/Michigan Identification
City, State, ZIP
Home Telephone
8B. Name (Last, First, Middle, Jr./Sr./III)
Social Security Number
Title
Date of Birth
Residence Address (Number, Street)
Driver License/Michigan Identification
City, State, ZIP
Home Telephone