Form 807 - Michigan Composite Individual Income Tax Return - 2012 Page 3
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52012 807, Page 3
Name of Partnership, S Corporation or Other Flow Through Entity
Federal Employer Identification Number
SCHEDULE A: SCHEDULE OF PARTICIPANTS
Column 1:
Column 2:
Column 3:
Distributive Share
Distributive Share
Withholding Paid on Behalf of the
of Michigan Income
of Michigan Tax
Participant *
Recipient FEIN/SSN
3a:
3b:
Payer FEIN
Withholding
Recipient Name and Address
Recipient FEIN/SSN
3b:
3a:
Withholding
Payer FEIN
Recipient Name and Address
Recipient FEIN/SSN
3a:
3b:
Payer FEIN
Withholding
Recipient Name and Address
Recipient FEIN/SSN
3b:
3a:
Withholding
Payer FEIN
Recipient Name and Address
Recipient FEIN/SSN
3a:
3b:
Payer FEIN
Withholding
Recipient Name and Address
Check here if additional page(s)
used. Enter totals from additional
page(s), if applicable.
Total columns 1, 2 and 3b. Carry
total from Column 1 to line 16,
and Column 3b to line 23, on your
Composite return
* Do not include withholding claimed on any other Michigan composite return or refunded on any Michigan Annual Flow-
Through Withholding Reconciliation Return (Form 4918).
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