Form 3598 - Indian Country Information Inquiry
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1Michigan Department of Treasury
3598 (Rev. 01-12)
Reset Form
"Indian Country" * Information Inquiry
Issued under authority of P.A. 327 of 1993, as amended; P.A. 150 of 1927, as amended;
Federal Employer Identification No. (If you do not have a FEIN, a
and P.A. 167 of 1933, as amended. Filing is voluntary; however, this form must be filed to
number will be assigned to you.)
receive consideration for refunds of Tobacco Products tax, Motor Fuel tax or Sales tax.
1. Name of Tribe (whose "Indian Country" * the business is located in)
Michigan Department of Treasury
3598 (Rev. 5/03)
2. Name of Business
"Indian Country" Information Inquiry
3. Name of Owner (Officer if a corporation)
Issued under authority of P.A. 327 of 1993, as amended, P.A. 150 of 1927, as amended, and
P.A. 167 of 1933, as amended. Filing is voluntary, however, this form must be filed to receive
Federal Employer Identification Number (FEIN). If you do not
consideration for refunds of tobacco products tax, motor fuel tax or sales tax.
4. Address where legal contact should be made (enter number and street)
have a FEIN, a number will be assigned to you.
5. City, State, Zip Code
6. Address of the actual location of the business in Michigan and within "Indian Country" * (enter number and street; cannot be a P.O. Box Number)
7. City, State, Zip Code
8. Legal Physical Description of property in Michigan and within "Indian Country" *
CERTIFICATION
By checking this box and signing below, I hereby certify that the business identified on line 2 of this form is located within the
"Indian Country" of the tribe identified on line 1.
9. Type or Print Name
Title
Date
Title
Signature
Telephone Number
Where the retail business is owned by a federally recognized Indian Tribe, the signing of this form shall not be construed to represent
any concession of existing sovereignty.
* "Indian Country" as defined in 18 U.S.C. , Section 1151.
Send completed forms to:
Michigan Department of Treasury
Special Taxes Division
P.O. Box 30474
Lansing, MI 48909-7974
Questions? Call (517) 636-4630. Forms can also be faxed to (517) 636-4631.
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