Form 4920 - Michigan Flow-Through Withholding Opt-Out Schedule - 2012
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Michigan Department of Treasury
Attachment 2
4920 (Rev. 03-12)
2012 Michigan Flow-Through Withholding Opt-Out Schedule
Issued under authority of Public Act 38 of 2011.
Flow-Through Entity (FTE) Name
FTE FEIN
A
B
C
Distributive Income
C Corporation Information
C Corporation FEIN
(see instructions)
Name
Address
City
State
ZIP/Postal Code
Name
Address
City
State
ZIP/Postal Code
Name
Address
City
State
ZIP/Postal Code
Name
Address
City
State
ZIP/Postal Code
Name
Address
City
State
ZIP/Postal Code
Name
Address
City
State
ZIP/Postal Code
Name
Address
City
State
ZIP/Postal Code
If more space is needed, include additional copies of Form 4920. Repeat the taxpayer name and FEIN at the top of every copy.
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0000 2012 54 01 27 2
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