Form 4917 - Michigan Flow-Through Withholding Quarterly Return - 2012
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1Michigan Department of Treasury
Due Date (MM-DD-YYYY)
4917 (Rev. 11-11)
2012 MICHIGAN Flow-Through Withholding Quarterly Return
Quarter Ending Date (MM-DD-YYYY)
Issued under authority of Public Act 38 of 2011. See instructions for filing guidelines.
Name
1. Non-resident Individual
Flow-Through Withholding .. 1.
00
Street Address
2. Corporate Flow-Through
Withholding ........................ 2.
00
City
State
ZIP/Postal Code
3. Penalty and Interest........... 3.
00
FEIN/Account Number
Organization Type Code (see instr.)
4. Total Payment .................... 4.
00
Mail to: Michigan Department of Treasury, PO Box 30800, Lansing MI 48909-8300. Write your FEIN, tax year, and “FTW Q” on the check; make payable to “State of Michigan.”
+
9999 2012 02 01 27 7
Michigan Department of Treasury
Due Date (MM-DD-YYYY)
4917 (Rev. 11-11)
2012 MICHIGAN Flow-Through Withholding Quarterly Return
Quarter Ending Date (MM-DD-YYYY)
Issued under authority of Public Act 38 of 2011. See instructions for filing guidelines.
Name
1. Non-resident Individual
Flow-Through Withholding .. 1.
00
Street Address
2. Corporate Flow-Through
Withholding ........................ 2.
00
City
State
ZIP/Postal Code
3. Penalty and Interest........... 3.
00
FEIN/Account Number
Organization Type Code (see instr.)
4. Total Payment .................... 4.
00
Mail to: Michigan Department of Treasury, PO Box 30800, Lansing MI 48909-8300. Write your FEIN, tax year, and “FTW Q” on the check; make payable to “State of Michigan.”
+
9999 2012 02 01 27 7
Michigan Department of Treasury
Due Date (MM-DD-YYYY)
4917 (Rev. 11-11)
2012 MICHIGAN Flow-Through Withholding Quarterly Return
Quarter Ending Date (MM-DD-YYYY)
Issued under authority of Public Act 38 of 2011. See instructions for filing guidelines.
Name
1. Non-resident Individual
Flow-Through Withholding .. 1.
00
Street Address
2. Corporate Flow-Through
Withholding ........................ 2.
00
City
State
ZIP/Postal Code
3. Penalty and Interest........... 3.
00
FEIN/Account Number
Organization Type Code (see instr.)
4. Total Payment .................... 4.
00
Mail to: Michigan Department of Treasury, PO Box 30800, Lansing MI 48909-8300. Write your FEIN, tax year, and “FTW Q” on the check; make payable to “State of Michigan.”
+
9999 2012 02 01 27 7
Michigan Department of Treasury
Due Date (MM-DD-YYYY)
4917 (Rev. 11-11)
2012 MICHIGAN Flow-Through Withholding Quarterly Return
Quarter Ending Date (MM-DD-YYYY)
Issued under authority of Public Act 38 of 2011. See instructions for filing guidelines.
Name
1. Non-resident Individual
Flow-Through Withholding .. 1.
00
Street Address
2. Corporate Flow-Through
Withholding ........................ 2.
00
City
State
ZIP/Postal Code
3. Penalty and Interest........... 3.
00
FEIN/Account Number
Organization Type Code (see instr.)
4. Total Payment .................... 4.
00
Mail to: Michigan Department of Treasury, PO Box 30800, Lansing MI 48909-8300. Write your FEIN, tax year, and “FTW Q” on the check; make payable to “State of Michigan.”
+
9999 2012 02 01 27 7
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