Form 4763 - Michigan E-File Authorization For Business Taxes Mi-8879 - 2014

ADVERTISEMENT

Michigan Department of Treasury
4763 (Rev. 11-14), Page 1
2014 MICHIGAN e-file Authorization for Business Taxes MI-8879
Do not send this form to the Michigan Department of Treasury. Keep this form for your records. See instructions.
MM-DD-YYYY
MM-DD-YYYY
Return is for calendar year 2014 or for tax year beginning:
and ending:
Federal Employer Identification Number (FEIN)
Company Name
PArT 1: TAx reTurN INforMATIoN —
The taxpayer should obtain and keep a copy of the return.
Corporate Income Tax (CIT) or Michigan Business Tax (MBT) Annual return
00
1. Tax due ..............................................................................................................................................................
1.
00
2. Credit forward ....................................................................................................................................................
2.
00
3. Refund ...............................................................................................................................................................
3.
PArT 2: offICer or PArTNer DeClArATIoN AND e-fIle AuTHorIzATIoN
I declare, under penalty of perjury, that I am an officer or partner of the above company and that I have examined a copy of my electronic
business tax return and accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and
complete. I further declare that the amounts in Part 1 above are the amounts from my electronic business tax return. I consent to allow
my intermediate service provider (ISP), transmitter, or electronic return originator (ERO) to send my return to the IRS and subsequently
by the IRS to the Michigan Department of Treasury. I also consent to the Michigan Department of Treasury sending my ERO, transmitter,
and/or ISP an acknowledgment of receipt of transmission and an indication of whether the return is accepted or rejected.
PIN Authorization (Check one box only)
I authorize the identified ERO Firm to enter or generate my
ERO Firm Name
PIN as my authorization for my tax year 2014 electronically
filed tax return. (The ERO must complete Part 3.)
I will enter my PIN as my authorization for my tax year 2014
PIN (Enter five numbers, but do not enter all zeros)
electronically filed tax return.
Authorized Signature for Tax Matters
Date
Authorized Signer’s Name (print or type)
Title
PArT 3: eleCTroNIC reTurN orIGINATor (ero) AND PrePArer DeClArATIoN
I declare, under penalty of perjury that I have reviewed the above taxpayer’s return, accompanying schedules and statements and that the
entries on this form are complete and correct to the best of my knowledge, either as the ERO, ISP or Paid Preparer. If I am only an ISP, I
understand that I am not responsible for reviewing the taxpayer’s return. I declare however, that this form accurately reflects the data on
the return. I have obtained the taxpayer’s signature on this form before transmitting this return to the IRS and subsequently by the IRS to
the Michigan Department of Treasury. I have provided the taxpayer with a copy of all forms and information to be filed with the IRS and the
Michigan Department of Treasury. I have followed all other requirements described in Publication 3112, IRS e-file Application and Participation,
Publication 4163, Modernized e-File (MeF) Information for Authorized IRS e-file Providers for Business Returns, and any requirements
specified by the Michigan Department of Treasury.
ERO Signature
Date
Firm Name (or name of ERO, if self-employed)
FEIN or PTIN
Address
City
State
ZIP Code
If I also am the Paid Preparer, I declare under penalty of perjury that I have examined the above taxpayer’s return and accompanying
schedules and statements and to the best of my knowledge, they are true, correct and complete. This declaration is based on all information
of which I have knowledge.
Preparer’s Signature
Date
Preparer’s Name (print or type)
FEIN or PTIN
Address
City
State
ZIP Code

ADVERTISEMENT

00 votes

Related Articles

Related forms

Related Categories

Parent category: Financial
Go
Page of 2