Form 4897 - Michigan Corporate Income Tax Data On Unitary Business Group Members - 2013

Attachment 10

Michigan Department of Treasury

4897 (Rev. 03-13)

2013 MICHIGAN Corporate Income Tax Data on Unitary Business Group Members

Issued under authority of Public Act 38 of 2011.

Complete a separate copy of this schedule for each standard taxpayer member of the UBG, with or without nexus.

1. Designated Member Name

2. Designated Member FEIN

3. Member Name

4. Member FEIN

5. Member Street Address

6.

Check if a special sourcing formula for

transportation services was used in the

City

State

ZIP/Postal Code Country Code

sourcing of Sales to Michigan.

Beginning

Ending

9.

Check if nexus with Michigan.

7. Federal tax period included in return

(MM-DD-YYYY) ........................................

10. NAICS Code

8. If part-year member, enter

membership dates (MM-DD-YYYY) .........

Business and Capital Loss Carryforward — Lines 11 and 12, enter as a positive number.

00

11. Available CIT business loss carryforward from previous period’s CIT return ...................................................... 11.

00

12. Carryback or carryover of a capital loss .............................................................................................................. 12.

Sales and Gross Receipts

00

13. Michigan sales. (If no Michigan sales, enter zero.) ............................................................................................. 13.

00

14. Proportionate Michigan sales from unitary Flow-Through Entities (FTEs) .......................................................... 14.

00

15. Michigan sales eliminations (see instructions) .................................................................................................... 15.

00

16. Total sales............................................................................................................................................................ 16.

00

17. Proportionate total sales from unitary FTEs ........................................................................................................ 17.

00

18. Total sales eliminations (see instructions) ........................................................................................................... 18.

00

19. Gross Receipts (see instructions)........................................................................................................................ 19.

00

20. Apportioned gross receipts from a FTE ............................................................................................................... 20.

Member Business Income

00

21. Federal taxable income from U.S. Form 1120 ..................................................................................................... 21.

00

22. Domestic production activities deduction based on IRC § 199 (see instructions) ............................................... 22.

00

23. Miscellaneous (see instructions) ......................................................................................................................... 23.

24. Adjustments due to decoupling of Michigan depreciation from IRC § 168(k). If negative, enter as negative:

00

a. Net bonus depreciation adjustment .................................................... 24a.

00

b. Gain/loss adjustment on sale of an eligible depreciable asset ........... 24b.

00

c. Add lines 24a and 24b. If negative, enter as negative................................................................................. 24c.

00

25. Group eliminations from business income for this member (see instructions) .................................................... 25.

00

26. Business Income. Add lines 21, 22, 23 and 24c, and subtract line 25. If negative, enter as negative .............. 26.

Additions to Business Income

00

27. Interest income and dividends derived from obligations or securities of states other than Michigan ...................

27.

00

28. Taxes on or measured by net income .................................................................................................................. 28.

00

29. Any carryback or carryover of a federal net operating loss (enter as a positive number) ..................................... 29.

00

30. Royalty, interest, and other expenses paid to a related person that is not a UBG member of this taxpayer ........ 30.

00

31. Miscellaneous (see instructions) ......................................................................................................................... 31.

Subtractions from Business Income

00

32. Income from non-unitary FTEs (Enter loss as a negative; include Form 4898; see instructions) ............................... 32.

00

33. Dividends and royalties received from persons other than U.S. persons and foreign operating entities ............ 33.

00

34. Interest income derived from United States obligations ...................................................................................... 34.

00

35. Miscellaneous (see instructions) ......................................................................................................................... 35.

Payments

00

36. Overpayment credited from prior period return (MBT or CIT) ............................................................................. 36.

00

37. Estimated tax payments ...................................................................................................................................... 37.

00

38. Flow-Through Withholding payments .................................................................................................................. 38.

00

39. Tax paid with request for extension ..................................................................................................................... 39.

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