Form 4589 - Michigan Business Tax Film Credit Assignment - 2012
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1
2
3Michigan Department of Treasury
4589 (Rev. 03-12)
2012 MICHIGAN Business Tax Film Credit Assignment
Issued under authority of Public Act 36 of 2007.
INSTRUCTIONS: The assignor, after completing and signing this form, must file it with the Michigan Department of Treasury (Treasury) at
the mailing address below. After processing, Treasury will return this assignment form to the assignor, who must distribute a copy of this
assignment form to the assignee named in Part 2 and/or Part 3 for submission with the tax return on which a film credit is being claimed.
Contact Treasury at (517) 373-9600 with questions.
PART 1: ASSIGNOR IDENTIFICATION
2. Federal Employer Identification Number (FEIN) or TR Number
1. Assignor Name
4. Tax Year End (MM-DD-YYYY)
Street Address
3. Project Number
Country Code 5. Date Project was Certified as Completed (MM-DD-YYYY)
City
State
ZIP/Postal Code
If not assigning/reassigning the Film Production Credit, skip to PART 3.
PART 2: FILM PRODUCTION CREDIT
6. a.
Original Assignment
b.
Reassignment
7. Credit amount from Post-Production Certificate of Completion provided by the Michigan Film Office (original
00
assignment) or credit amount from the immediately prior in time assignment form (reassignment) .....................
7.
8.
A
B
C
D
E
Assignee
Date Assignee’s
% of Credit
Account Number
Tax Year Ends
to be
Assigned Credit
(MM-DD-YYYY)
Assignee Name
Assigned
(FEIN or TR Number)
Multiply line 7 by column D.
If not assigning/reassigning the Film Infrastructure Credit, skip to PART 4.
PART 3: FILM INFRASTRUCTURE CREDIT
9. a.
Original Assignment
b.
Reassignment
10. Film Infrastructure Credit amount from Investment Expenditure Certificate (original assignment) or credit
00
amount from the immediately prior in time assignment form (reassignment) ........................................................
10.
11.
A
B
C
D
E
Assignee
Date Assignee’s
% of Credit
Account Number
Tax Year Ends
to be
Assigned Credit
(MM-DD-YYYY)
Assignee Name
Assigned
(FEIN or TR Number)
Multiply line 10 by column D.
PART 4: ASSIGNOR CERTIFICATION
I certify that the information provided on this form is accurate.
Authorized Signature for Tax Matters
Date
Contact Phone Number
Authorized Signer’s Name (print or type)
Title
PART 5: TREASURY APPROVAL
Authorized Signature
Date
Authorized Signer’s Printed Name
Authorized Signer’s Title
Mail completed form to: Tax Policy Division, Michigan Department of Treasury, 430 W. Allegan St., Lansing, MI 48922
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