Michigan Sales, Use, And Withholding Tax Forms And Instructions (Page 10 of 16) in pdf

Michigan Sales, Use, And Withholding Tax Forms And Instructions Page 10

Form 165, Page 2

Taxpayer's Business Name

Account Number

Type of Business Ownership (check one only)

Michigan Corporation

Individual

Non-Michigan Corporation

Trust or Estate (Fiduciary)

Subchapter S

Husband - Wife

Subchapter S

Joint Stock Club or Investment Company

General Partnership

Social Club or Fraternal Organization

Limited Partnership

Other (Explain)

Limited Liability Company Taxed As:

Individual

Partnership

C Corporation

S Corporation

Disregarded Entity

Enter the reason for amending return. Include your account number on each page being submitted. (Required)

Signature (you are required to complete all information requested below)

I declare under penalty of perjury that this return

I declare under penalty of perjury that this return is true and complete to the best of my knowledge.

is based on all information of which I have any

By checking this box, I authorize Treasury to discuss my return with the designated preparer.

knowledge.

Signature of Taxpayer's Ofﬁ cal Representative (must be an Owner, Ofﬁ cer, Member, Manager, or Partner)

Preparer's Signature, Address, Telephone and ID Number

Print Ofﬁ cal Representative's Name

Date

Ofﬁ cal Representative's Title (Owner/Ofﬁ cer/Member/Manager/Partner) (Required)

Telephone Number

Taxpayer's FEIN or Social Security Number

Mailing Instructions:

If sending an amended annual return, check the amended return box on page 1 of this return, and refer to

page 6 of the SUW Instruction Book (Form 78) for amended return mailing addresses and other instructions.

If enclosing payment with your annual return, mail to:

Michigan Department of Treasury

Department 78172

P.O. Box 78000

Detroit, MI 48278-0172

If requesting a credit to your account (amount on line 23) or a refund (amount on line 24), mail to:

Michigan Department of Treasury

P.O. Box 30779

Lansing, MI 48909

If no payment is enclosed with your annual return, mail to:

Michigan Department of Treasury

Lansing, MI 48930

is a secure Web site designed speciﬁ cally to protect your tax information. Use this Web

site to check the status your Sales, Use, and Withholding transactions and ask speciﬁ c questions about your account.

Michigan Sales, Use, And Withholding Tax Forms And Instructions Page 10

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