Form 2078 - Request For Michigan Tax Return Information - Michigan Department Of Treasury

Download a blank fillable Form 2078 - Request For Michigan Tax Return Information - Michigan Department Of Treasury in PDF format just by clicking the "DOWNLOAD PDF" button.

Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.

Complete Form 2078 - Request For Michigan Tax Return Information - Michigan Department Of Treasury with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.

Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.

Reset Form

Michigan Department of Treasury

2078 (Rev. 03-12)

Request for Michigan Tax Return Information

Issued under authority of Public Act 122 of 1941, as amended.

PART 1: REQUESTING AGENCY INFORMATION

Name of Government Unit Requesting Information

Telephone Number

Address (Number and Street)

City

State

ZIP Code

We are requesting information per MCL 205.28 (1)(f) and an agreement between the agency named above and the Michigan Department of Treasury.

Please provide the information on the individual or business named below.

PART 2: INDIVIDUAL TAXPAYER

Taxpayer Last Name

First Name

Social Security Number

Secondary Taxpayer Last Name

First Name

Social Security Number

Address (Street)

City

State

ZIP Code

PART 3: BUSINESS TAXPAYER

Business or Corporation Name

Federal Employer ID No. (FEIN) or Michigan ID No.

Address (Street)

City

State

ZIP Code

Names of Owners or Partners

Check this box if the information must be certified by the Disclosure Officer and is expected to be presented in court.

Type of tax return information needed:

For tax years:

Individual

Business

Other: ______________________

Specify other information needed:

Reason for request:

I declare that I am authorized to request and receive the above information under the exchange agreement between the Michigan Department of

Treasury and the agency named above (Government Unit).

I understand that any Michigan Department of Treasury tax returns or tax return information made available to me will not be divulged or made known in any manner to any

person except as may be necessary in the performance of my official duties. Access to Treasury information is allowed on a need-to-know basis to perform my official duties.

I further understand that under the Michigan Revenue Act, MCL 205.28(1)(f) I may not willfully browse any return or information contained in a return. Browsing is defined as

examining a return or return information acquired by a person or another person without authorization or without a need to know the information to perform official duties.

Agency Discipline: Treasury may pursue internal sanctions for unauthorized accessing, browsing, or disclosing state or federal tax returns or tax return information,

regardless of whether criminal prosecution is taken.

Michigan Penalties: MCL 205.28(1)(f) provides that you may not willfully browse any Michigan tax return or information contained in a return. Browsing is defined as examin-

ing a return or return information acquired without authorization and without a need to know the information to perform official duties. Violators of §28(1)(f) are guilty of a

felony and subject to fines of $5,000 or imprisonment for five years, or both per the Michigan Revenue Act, MCL 205.28(2). State employees will be discharged from state

service upon conviction.

Any person who violates any other provision of the Revenue Act, MCL 205.1, et seq., or any statute administered under the Revenue Act, will be guilty of a misdemeanor and

fined $1,000 or imprisoned for up to one year, or both, MCL 205.27(4).

This form and any attached return information must be returned to your department liaison in charge of tracking, receiving and destroying Michigan tax return information.

Signature

Date

Signature of Agency Head/Designee

Date

Print Name of Employee Initiating Request

Print Name of Agency Head/Designee

PART : TO BE COMPLETED BY TREASURY DISCLOSURE OFFICER

1. The attached information is furnished for tax year(s) __________________________________________________________________________________.

2. No record of filing a return/credit for tax year(s) ______________________________________________________________________________________.

3. No tax record exists for the previous five years under the account number provided.

4. The account number provided is being used by another taxpayer.

5. We are unable to locate a business tax record under the name(s) provided. Submit an FEIN or Michigan ID number for a more thorough search.

6. Other _______________________________________________________________________________________________________________________.

Disclosure Officer

Date

Allow 60 days to process

your request.

Send this form to: Disclosure Officer, Michigan Department of Treasury, Office of Privacy and Security, Disclosure Unit, 430 W. Allegan Street, Lansing,

MI 48922.