Form 807 - Michigan Composite Individual Income Tax Return - 2004
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1
2Reset Form
Michigan Department of Treasury
This form is issued under authority of P.A. 281 of 1967, as
807 (Rev. 1-05)
amended. Failure to file may result in the assessment of
penalty and interest and could result in the revocation of
2004 MICHIGAN
filing agreement.
Composite Individual Income Tax Return
This return is due April 15, 2005. Type or print clearly in blue or black ink.
42.
41
Federal Employer Identification or TR Number
. Name of Partnership, S Corporation or Other Flow-Through Entity
43.
Mailing Address (Street, P.O. Box or Rural Route No.)
44.
State
ZIP Code
City, Village or Township
NOTE: Pages 1, 2 and 3 of the U.S. 1065 or 1120S, the MI-1040H, a list of participants and a list of
nonparticipants must be attached to this return. See instructions.
4
.00
5.
Ordinary income (loss) from line 22 of U.S. 1065 or line 21 of U.S. 1120S
5.
.00
4
6.
Additions (from line 35, page 2)
6.
.00
7.
Subtotal. Add lines 5 and 6
7.
.00
4
8.
Subtractions (from line 38, page 2)
8.
.00
9.
Total income subject to apportionment. Subtract line 8 from line 7
9.
%
4
10.
Apportionment percentage from MI-1040H. (Caution! See instructions.)
10.
.00
11.
Total Michigan apportioned income. Multiply line 9 by the percentage on line 10
11.
.00
4
12.
Michigan allocated income or (loss) (from line 43, page 2)
12.
.00
13.
Total Michigan income. Add lines 11 and 12
13.
.00
4
14.
Enter Michigan income that is attributable to Michigan residents
14.
.00
4
15.
Enter Michigan income that is attributable to nonparticipating nonresidents
15.
.00
16.
Enter Michigan income that is attributable to participants
16.
.00
17.
Exemption allowance (from line 49, page 2)
4
17.
.00
4
18.
SEP, SIMPLE or qualified plan deductions (from line 52, page 2)
18.
.00
19.
Add lines 17 and 18
19.
.00
20.
Taxable income. Subtract line 19 from line 16
20.
.00
21.
Tax due. Multiply line 20 by 3.95% (.0395)
21.
.00
4
22.
Michigan extension payments and credit forward
22.
.00
4
23.
Withholding tax payments
23.
24.
If line 22 plus line 23 is less than line 21, enter TAX DUE.
.00
4
Include interest
and penalty
, if applicable
PAY
24.
.00
25.
If line 22 plus line 23 is more than line 21, enter overpayment
25.
.00
4
26.
Amount of line 25 to be credited to your 2005 estimated tax
26.
.00
4
27.
Subtract line 26 from line 25
REFUND
27.
CERTIFICATION
I declare under penalty of perjury that the information in this return and attachments is true and
I declare under penalty of perjury that this return is based on all
complete to the best of my knowledge. I have obtained the required Power of Attorney from each
information of which I have any knowledge.
of the members of this composite return and my firm will resolve the issue of any tax liability.
Preparer's Name, Address, PTIN and/or FEIN
Filer's Signature
Date
I authorize Treasury to discuss my return with my preparer.
Yes
No
Mailing: Make check payable to "State of Michigan." Write the firm's Federal Employer Identification Number, "Composite
Return" and Tax Year on the check. Mail return with payment (if applicable) to: Composite Return, Michigan Department of
Treasury, P.O. Box 30058, Lansing, MI 48909.
Continued on Page 2
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