Form 4894 - Michigan Corporate Income Tax Schedule Of Shareholders And Officers - 2012
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7Michigan Department of Treasury
Attachment 3
4894 (Rev. 06-12), Page 1
2012 MICHIGAN Corporate Income Tax Schedule of Shareholders and Officers
For all Corporations claiming the Small Business Alternative Credit
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
PART 1: QuAliFying DATA FoR The SmAll BuSineSS AlTeRnATive CReDiT
.
Complete Part 2 and Part 3 before completing Part 1. See instructions for definition of active shareholder.
1. Compensation and director fees of active shareholders. Add amounts in Part 2, column L, for each active
00
shareholder. Enter here and on Form 4893, line 7 .................................................................................................
1.
2. Compensation and director fees of officers. Add amounts in Part 2, column L, for each officer who is not an
00
active shareholder. Enter here and on Form 4893, line 8.......................................................................................
2.
PART 2: ShAReholDeRS AnD oFFiCeRS.
See instructions.
3. A
B
C
D
e
F
g
% Stock from Col. F
Check
% Stock with
Name of shareholder (including corporation, trust, or partnership),
FEIN or
(X) if
less any attribution
officer, or family member receiving compensation from the
between two active
Member
Social Security number
an
% Stock
attribution
of shareholder or officer
officer
directly owned
Number
business (Last, First, Middle)
(See instructions.)
shareholders
%
%
%
%
%
%
%
%
%
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%
Percent of stock (not listed above) owned by shareholders who own less than 10% and receive no compensation:
%
100
Total:
%
+
0000 2012 18 01 27 8
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