Form Mi-1045 - Application For Michigan Net Operating Loss Refund -

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Michigan Department of Treasury (Rev. 11-14), Page 1

Application for Michigan Net Operating Loss Refund MI-1045

Issued under authority of Public Act 281 of 1967. Type or print in blue or black ink.

Year (YYYY)

Month-Year (MM-YYYY)

For loss year

or for loss year beginning

and ending

Filer’s First Name

M.I.

Last Name

Filer’s Full Social Security No. (Example: 123-45-6789)

If a Joint Return, Spouse’s First Name

M.I.

Last Name

Spouse’s Full Social Security No. (Example: 123-45-6789)

Home Address (Number, Street, or P.O. Box)

City or Town

State

ZIP Code

IMPORTANT: Use your U.S. Form 1040 to complete this form. Do not consider net operating losses from other years. Do not include

income and losses sourced to other states, income and losses from oil and gas production and nonferrous metallic minerals extraction

that are subject to Michigan severance tax, or a federal net operating loss deduction (NOLD).

PART 1: COMPUTING THE NET OPERATING LOSS (NOL) (see instructions, page 2).

1. Wages, salaries, tips, etc. ......................................................................................................................

2. Interest income ......................................................................................................................................

3. Dividends. ..............................................................................................................................................

4. Business income or loss (attach U.S. Schedules C and F) ...................................................................

5. Capital gain or loss (attach U.S. Schedule D) .......................................................................................

6. Other gains or losses (attach U.S. Form 4797) .....................................................................................

7. Pension, IRA, and annuities included in Adjusted Gross Income (AGI) ................................................

8. Net rent or royalty income .....................................................................................................................

9. Income or losses from partnerships, estates, trusts and S corporations (attach U.S. Schedule E) ........

10. Other (e.g., all state and local refunds, alimony, taxable Social Security, unemployment

compensation) Describe:____________________________________________________________ 10.

11. Total Michigan Gross Income. Add lines 1 through 10. ......................................................................... 11.

12. ADJUSTMENTS: Only list adjustments to Michigan-sourced income

a. Payments to a retirement plan as an individual or self-employed person 12a.

b. Deduction for self-employment tax and self-employed health insurance 12b.

c. Educator expenses and/or moving expenses .......................................... 12c.

d. Alimony paid and/or penalty for early withdrawal of savings ................... 12d.

e. Domestic production activities deduction (DPAD) sourced to Michigan .. 12e.

f. Other adjustments to income including health savings account deduction 12f.

13. Total adjustments. Add lines 12a through 12f ....................................................................................... 13.

14. Michigan AGI. Subtract line 13 from line 11. If greater than zero, you do not have an NOL. ................ 14.

15. Nonbusiness deductions: Add lines 12a, 12d and 12f .................................

15.

16. Nonbusiness income included in line 11

a. Interest income .............................................

16a.

16b.

b. Dividend income ...........................................

c. Net nonbusiness capital gains

(before any allowable exclusion) ..................

16c.

16d.

d. Pension, IRA, and annuities .........................

e. Alimony received ..........................................

16e.

16f.

f. Other income .................................................

17. Total nonbusiness income. Add lines 16a through 16f ................................

17.

18. Excess of nonbusiness deductions over nonbusiness income, subtract

line 17 from line 15. If less than zero, enter “0” ............................................

18.

19. Excess capital loss deduction (enter as a positive number. See instr.) ........

19.

20. DPAD sourced to Michigan (enter as a positive number) .............................

20.

21. Add lines 18, 19 and 20 ......................................................................................................................... 21.

22. Net operating loss. Combine lines 14 and 21. If greater than zero, STOP; you do not have an NOL .. 22.

The Michigan NOL may be carried back or forward in the same manner as is allowed by the Internal Revenue Code (IRC), which is typically back two years

and forward twenty. See U.S. Form 1045 for exceptions. An election to forego the carryback period must be filed in the same manner as required by the

IRC (attach a statement to your return for the NOL year). Any loss in excess of income subject to Michigan tax must be carried forward to the next year.

0000 2014 73 01 27 8

Continue on page 2. This form cannot be processed if page 2 is not completed and attached.