Form 5114 - 2013 Michigan Corporate Income Tax Affiliated Group Election To File As A Unitary Business Group

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Michigan Department of Treasury
5114 (Rev. 01-14)
Reset Form
2013 MICHIGAN Corporate Income Tax Affiliated Group Election
to File as a Unitary Business Group
Issued under authority of Public Act 266 of 2013.
Designated Member Name
Designated Member FEIN
NOTE: The Designated Member (DM) name and Federal Employer Identification Number (FEIN) above must match the DM
name and FEIN used on the Corporate Income Tax (CIT) Annual Return (Form 4891), CIT Amended Return (Form 4892),
CIT Annual Return for Financial Institutions (Form 4908), or CIT Amended Return for Financial Institutions (Form 4909).
CErTIFICATION
On behalf of the taxpayer named above, I am making the affiliated group election to file as a Unitary Business Group
under the CIT, effective with the 2013 tax year.
Authorized Signature for Tax Matters
Authorized Signer’s Name (print or type)
Date
Title
Telephone Number
Complete and mail this form to:
Tax Processing Bureau
Business Taxes Division
Michigan Department of Treasury
PO Box 30427
Lansing, MI 48909
Retain a copy for your records.
See instructions on Page 2

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