Form 511 - Tax Status Letter Request
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1Michigan Department of Treasury
511 (Rev. 09-12)
Reset Form
Tax Status Letter Request
Issued under authority of Public Act 122 of 1941
IMPORTANT: A tax status letter does not constitute a certificate of good standing issued by the Department of Licensing and Regulatory
Affairs and relating to annual corporate reports and privilege fees.
Date
Current Business or Corporate Name
Federal Employer Identification Number (FEIN)
Corporate Identification (CID) Number
Street Address
City
State
ZIP Code
Date Incorporated / Qualified (mm/dd/yyyy)
State Incorporated In
Requested By (print name)
List Any Corporate Name Change(s)
Date of Change
Street Address (if different from above)
1.
2.
City
State
ZIP Code
3.
(use space below if necessary)
Certification
I declare under penalty of perjury that I am the owner, officer, or member of the business on which tax clearance is requested and that
:
the information is true. (Submit a Limited Power of Attorney (Form 3840) if not the owner, officer, or member)
Printed Name of Requestor
Title
Telephone Number
Signature of Requestor
Date
Complete the requested information in its entirety and send to:
Tax Clearance Section
Michigan Department of Treasury
P.O. Box 30168
Lansing, MI 48909
Contact us for assistance: (517) 636-5260
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Parent category: Financial