Form 4897 - Corporate Income Tax Data On Unitary Business Group Members - 2012
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6Michigan Department of Treasury
Attachment 10
4897 (Rev. 03-12)
2012 MICHIGAN Corporate Income Tax Data on Unitary Business Group Members
Issued under authority of Public Act 38 of 2011.
Complete a separate copy of this schedule for each standard taxpayer member of the UBG, with or without nexus.
1. Designated Member Name
2. Designated Member FEIN
3. Member Name
4. Member FEIN
5. Member Street Address
6.
Check if a special sourcing formula for
transportation services was used in the
City
State
ZIP/Postal Code Country Code
sourcing of Sales to Michigan.
Beginning
Ending
9.
Check if Nexus with Michigan.
7. Federal tax period Included in return
(MM-DD-YYYY) ........................................
10. NAICS Code
8. If part-year member, enter
membership dates (MM-DD-YYYY) .........
Business and Capital Loss Carryforward
00
11. Available CIT business loss carryforward from previous period’s CIT return. Enter as a positive number ......... 11.
00
12. Carryback or carryover of capital loss ................................................................................................................. 12.
Member Proration
%
13. Proration Percentage (see instructions) .............................................................................................................. 13.
Sales and Gross Receipts
00
14. Michigan sales. (If no Michigan sales, enter zero.) ............................................................................................. 14.
00
15. Michigan sales eliminations (see instructions) .................................................................................................... 15.
00
16. Total sales............................................................................................................................................................ 16.
00
17. Total sales eliminations (see instructions) ........................................................................................................... 17.
00
18. Gross Receipts (see instructions)........................................................................................................................ 18.
Member Business Income
00
19. Federal taxable income from U.S. Form 1120 ..................................................................................................... 19.
20. Domestic production activities deduction based on IRC § 199 reported on U.S. Form 8903, to the extent
00
deducted from federal taxable income ................................................................................................................ 20.
00
21. Miscellaneous (see instructions) ......................................................................................................................... 21.
22. Adjustments due to decoupling of Michigan depreciation from IRC § 168(k). If adjustment is negative,
enter as negative:
00
a. Net bonus depreciation adjustment .................................................... 22a.
00
b. Gain/loss adjustment on sale of an eligible depreciable asset ........... 22b.
00
c. Add lines 22a and 22b. If negative, enter as negative................................................................................. 22c.
00
23. Business Income. Add lines 19, 20, 21 and 22c. If negative, enter as negative ............................................... 23.
Additions to Business Income
00
24. Interest income and dividends derived from obligations or securities of states other than Michigan ...................
24.
00
25. Taxes on or measured by net income .................................................................................................................. 25.
00
26. Any carryback or carryover of a federal net operating loss (enter as a positive number) ..................................... 26.
00
27. Royalty, interest, and other expenses paid to a related person that is not a UBG member of this taxpayer ........ 27.
00
28. Miscellaneous (see instructions) ......................................................................................................................... 28.
Subtractions from Business Income
00
29. Income from Non-Unitary Flow-Through Entities (Enter loss as a negative; attach Form 4898; see instructions) ..... 29.
00
30. Dividends and royalties received from persons other than U.S. persons and foreign operating entities ............ 30.
00
31. Interest income derived from United States obligations ...................................................................................... 31.
00
32. Miscellaneous (see instructions) ......................................................................................................................... 32.
Payments
00
33. Overpayment credited from prior period return (MBT or CIT) ............................................................................. 33.
00
34. Estimated Tax Payments ..................................................................................................................................... 34.
00
35. Flow-Through Withholding Payments.................................................................................................................. 35.
00
36. Tax Paid with Request for Extension ................................................................................................................... 36.
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0000 2012 24 01 27 5
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