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Michigan Department of Treasury (Rev. 04-12), Page 1
Schedule W
2012 MICHIGAN Withholding Tax Schedule
Issued under authority of Public Act 281 of 1967.
1 4
0123456789
Type or print in blue or black ink. Print numbers like this:
- NOT like this:
Attachment 13
INSTRUCTIONS:
If you had Michigan income tax withheld in 2012, you must complete a Withholding Tax Schedule (Schedule W) to
claim the withholding on your Individual Income Tax Return (MI-1040, line 29). Report military pay in Table 1 even if no Michigan tax was
withheld. Attach your completed Schedule W to Form MI-1040 or MI-1040X where applicable. See complete instructions on page 2 of this
form. If you need additional space, attach another Schedule W.
1. Filer’s First Name
M.I.
Last Name
2. Filer’s Social Security No. (Example: 123-45-6789)
If a Joint Return, Spouse’s First Name
M.I.
Last Name
3. Spouse’s Social Security No. (Example: 123-45-6789)
TABLE 1: MICHIGAN TAX WITHHELD ON W-2, W-2G or CORRECTED W-2 FORMS
A
C
D
E
B —
Employer’s federal
identification number
Box 1 — Wages, tips,
Box 17 — Michigan
Enter “X” for:
(Example: 38-1234567)
Box c — Employer’s name
other compensation
income tax withheld
Filer or Spouse
00
00
00
00
00
00
00
00
00
00
00
00
Enter Table 1 Subtotal from additional Schedule W forms (if applicable) .....................................................
00
4.
4. SUBTOTAL. Enter total of Table 1, column E ............................................................................
00
TABLE 2: MICHIGAN TAX WITHHELD ON 1099
A
C
D
E
B —
Payer’s federal
identification number
Taxable pension distribution,
Michigan income
Enter “X” for:
(Example: 38-1234567)
Payer’s name
misc. income, etc. (see instr.)
tax withheld
Filer or Spouse
00
00
00
00
00
00
00
00
00
00
00
00
Enter Table 2 Subtotal from additional Schedule W forms (if applicable) .....................................................
00
5. SUBTOTAL. Enter total of Table 2, column E ............................................................................
5.
00
+
0000 2012 57 01 27 6
Continue on page 2.