Form 4590 - Michigan Business Tax Annual Return For Financial Institutions - 2012 Page 2

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4590, Page 2
FEIN or TR Number
00
29. Recapture of Certain Business Tax Credits from Form 4587, line 13 ...................................................................
29.
00
30. Total MBT Tax Liability. Add lines 28 and 29 ....................................................................................................
30.
00
31. Corporate Income Tax adjustment from Form 4975, line 17 ................................................................................
31.
00
32. Total Tax Liability. Add lines 30 and 31 ..............................................................................................................
32.
PART 2: PAYMENTS, REFUNDABLE CREDITS AND TAX DUE
00
33. Overpayment credited from prior return ..........................................................
33.
00
34. Estimated tax payments ..................................................................................
34.
00
35. Flow-Through Withholding payments ..............................................................
35.
00
36. Tax paid with request for extension .................................................................
36.
00
37. Refundable credits from Form 4574, line 23 ...................................................
37.
38. Total Payments. Add lines 33 through 37. (If not amending, then skip to line 40) ...............................................
38.
00
a. Payment made with the original return ................................. 39a.
00
AMENDED
39.
RETURN
b. Overpayment received on the original return ....................... 39b.
00
ONLY
c. Add lines 38 and 39a and subtract line 39b from the sum ... .................................................... 39c.
00
00
40. TAX DUE. Subtract line 38 (or line 39c, if amending) from line 32. If less than zero, leave blank .......................
40.
41. Underpaid estimate penalty and interest from Form 4582, line 38 ........................................................................
41.
00
% =
00
00
00
42. Annual return penalty (a)
(b)
plus interest of (c)
. Total ..... 42d.
00
43. PAYMENT DUE. If line 40 is blank, go to line 44. Otherwise, add lines 40, 41 and 42d .....................................
43.
PART 3: REFUND OR CREDIT FORWARD
44. Overpayment. Subtract lines 32, 41 and 42d from line 38 (or line 39c, if amending). If less than zero, leave
00
blank (see instructions)..........................................................................................................................................
44.
00
45. CREDIT FORWARD. Amount on line 44 to be credited forward and used as an estimate for next MBT tax year ....
45.
00
46. REFUND. Amount on line 44 to be refunded.........................................................................................................
46.
Taxpayer Certification.
Preparer Certification.
I declare under penalty of perjury that the information in
I declare under penalty of perjury that this
this 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.
Preparer’s PTIN, FEIN or SSN
By checking this box, I authorize Treasury to discuss my return with my preparer.
Authorized Signature for Tax Matters
Preparer’s Business Name (print or type)
Authorized Signer’s Name (print or type)
Date
Preparer’s Business Address and Telephone Number (print or type)
Title
Telephone Number
Return is due April 30 or on or before the last day of the 4th month after the close of the tax year.
Make check payable to “State of
WITHOUT PAYMENT - Mail return to:
WITH PAYMENT — Pay amount on line 43
Michigan.” Print taxpayer’s FEIN or
and mail check and return to:
TR Number, the tax year, and “MBT” on
Michigan Department of Treasury
Michigan Department of Treasury
the front of the check. Do not staple the
PO Box 30783
PO Box 30113
check to the return.
Lansing MI 48909
Lansing MI 48909
+
0000 2012 87 02 27 1

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