Form 4903 - Michigan Corporate Income Tax Withholding Opt-Out Schedule - 2012
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1
2
3Michigan Department of Treasury
Attachment 8
4903 (Rev. 03-12)
2012 Michigan Corporate Income Tax Withholding Opt-Out Schedule
Issued under authority of Public Act 38 of 2011.
Federal Employer Identification Number (FEIN)
Taxpayer Name (If Unitary Business Group, Name of Designated Member)
Federal Employer Identification Number (FEIN)
Unitary Business Groups Only: Name of Unitary Business Group Member Reporting on This Form
A
B
C
Distributive Income
Flow-Through Entity Information
Flow-Through Entity 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 4903. Repeat the taxpayer name and FEIN at the top of every copy.
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0000 2012 36 01 27 0
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