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Form 4, Page 2

Lines 8 and 10: If applicable, these lines must both be

Line 1: File a separate application for each tax type. Check

the box next to the appropriate tax. If filing a Composite Income

completed to avoid delays in processing.

Tax return (for nonresident partners or shareholders), check the

Penalty and Interest

“Fiduciary Tax” box.

Line 2: Enter the month and year your tax year ends, NOT the date

If the tax due is underestimated and sufficient payment is not

you are making the payment. For most individual income tax filers,

paid with the application for extension, interest will be due on the

this date is 12-2012.

unpaid or underpaid amount.

Fiscal Year Filers (CIT): See “Supplemental Instructions for

The interest rate is 1 percent above the adjusted prime rate and is

adjusted on January 1 and July 1. Interest is charged from the original

Standard Fiscal CIT Filers” in Form 4890.

Lines 3, 5, and 7: CIT, MBT, Fiduciary, and Composite filers, enter

due date of the return to the date the balance of the tax is paid.

your FEIN or TR number on line 3. Income Tax filers only, enter your

Any one of the following penalties may also apply to the unpaid tax:

Social Security number on line 5 (and line 7 if filing jointly).

• The initial penalty is 5 percent of tax due. Penalty increases

Line 4: Filers who have not been granted a federal extension

by an additional 5 percent per month or fraction thereof, after the

may request an extension for good cause. Examples of good

second month, to a maximum of 25 percent for failure to pay;

cause include, but are not limited to: (a) taxpayer’s initial return,

• 10 percent for negligence;

(b) taxpayer’s final return, (c) a change in accounting period, and

• 25 percent for intentional disregard of the law.

(d) taxpayer’s books and records are not available or complete.

NOTE: The inability to pay a tax due is not good cause.

When You Have Finished

Line 6: Check the box if you have been granted a federal

extension. Retain a copy of your federal extension for your files.

Detach Form 4 from the instructions and mail to the address on the

form. MBT filers who submit a properly completed request will

By checking the box on line 6, you are affirming that you have a

receive a written response at the legal address on file with Treasury.

federal extension in your possession. You must be able to produce

Income Tax and Fiduciary Tax filers will not receive a response.

a copy for verification, if requested.

Computation and Payment of Tax Due

Estimate tax liability for the year and pay any unpaid portion of the estimate with the application for extension.

A. Tax before credits .............................................................................................................

B. Credits (if any) .................................................................................................................

C. Total annual tax liability. Subtract line B from line A.

Enter here and carry to Form 4, line 9 .............................................................................

D. Payments made to date. Enter here and carry to Form 4, line 11 * .................................

E. Estimated balance due. Subtract line D from line C ........................................................

F. Amount paid with Form 4. Enter here and carry to Form 4, line 13 ...............................

* Payments made to date include withholding, estimated tax payments, a credit forward from the previous tax year, and any other payments

previously made for this tax year.

Form 4 - Instructions For Application For Extension Of Time To File Michigan Tax Returns Page 2

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