Form 4765 - Request For Sales Or Use Tax Exemption For Enrolled Resident Tribal Members Of Federally Recognized Indian Tribes Located In Michigan Page 2

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4765, Page 2
Instructions for form 4765, request for sales or use tax exemption
for enrolled resident tribal members of federally recognized Indian tribes
located in michigan
for use by members of tribes that do not have a tax agreement with michigan.
General Instructions: Tribe means the tribe in which
Line 14: If seeking a refund, enter the requested refund
you are enrolled. Reservation or Trust Lands means your
amount. Be sure to include original receipts showing that
tribe’s reservation or lands held in trust by the United States
Michigan sales tax was paid. Note that refunds under $1 will
government on behalf of yourself or your tribe, which are
not be issued.
located in Michigan.
part 2: seller InformatIon
This form is intended to be used only by members of tribes
Line 19: Indicate whether the seller is an individual or a
that do not have a tax agreement with the State of Michigan
retail business. If a retail business, identify the organizational
and who are asserting an exemption from Michigan sales or
structure. Examples include being organized as a corporation,
use taxes based upon federal Indian doctrine principles.
a partnership, a sole proprietorship, or the tribe.
Before submitting this form, read the Notice Regarding
NOTE: If the organizational structure of the seller is unknown,
Sales to Federally Recognized Indian Tribes or Their
write “unknown” in the space provided. The Michigan
Qualifying Members on the Michigan Department of
Department of Treasury (Treasury) will attempt to contact the
Treasury’s Native American Web site at
seller to obtain this information. Where such information is
/taxes. Once there, select “Business Information” along the
not obtainable, the request may be denied.
left margin and then “Native American.”
Line 20: If the seller is a tribal retail business, identify
part 1: fIler InformatIon
whether or not the business is wholly owned by the tribe or its
Line 5: Federally recognized tribes located in Michigan that
members.
do not have a tax agreement with Michigan are:
NOTE: If it is unknown whether the retail business if
• Keweenaw Bay Indian Community
wholly owned by your tribe or its members, check the box
“unknown.” Treasury will attempt to contact the seller to
• Lac Vieux Desert Band of Lake Superior Chippewa
obtain this information. Where such information is not
Indians
obtainable, the request may be denied.
Lines 9-12: Identify whether the activity or physical
Line 21: If the answer to line 20 is “yes,” list all of the owners
location is within your tribe’s legally recognized reservation
of any organization structure other than a corporation. Attach
boundaries or lands held in trust for your tribe or yourself by
additional sheets if necessary.
the United States Government. If the location is in Michigan
but is somewhere other than your tribe’s reservation or trust
NOTE: If all of the owners of any business other than a
lands, check “Other Michigan Location.” If the location is
corporation are unknown, write “unknown.” Treasury will
outside of Michigan, check “Out of State.”
attempt to contact the seller to obtain this information. Where
such information is not obtainable, the request may be denied.
Line 9: Identify where each of the identified components of
the transaction occurred. Some examples clarifying the various
part 3: CertIfICatIon
components are as follows:
The filer must sign and date the request.
Solicitation: Did the seller come to your home and solicit the
sale? Did you receive a solicitation in the mail?
Return the completed request to:
Payment: Did you pay at the seller’s location? Did you send
Michigan Department of Treasury
a check via mail? Did you charge via the telephone or the
P.O. Box 30427
internet?
Lansing, MI 48909
Exchange of possession: Did the seller deliver the item to
your home? Did the seller have the item delivered to your
home by another party? Did you pick up the item from the
seller’s location?
Line 11: Check each box that applies. For example, if the item
will be used on your tribe’s reservation, on trust lands, and at
other Michigan locations, check all three boxes.
Line 13: Indicate whether you are seeking a refund for taxes
already paid or an exemption letter to be sent to you to be
presented to the seller at the time of purchase.

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