Form 4577 - Michigan Business Tax Schedule Of Shareholders And Officers - 2012

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Attachment 07
Michigan Department of Treasury
4577 (Rev. 04-12), Page 1
2012 MICHIGAN Business Tax Schedule of Shareholders and Officers
For all Corporations claiming the Small Business Alternative or Start-Up Business Credits
Issued under authority of Public Act 36 of 2007.
Federal Employer Identification Number (FEIN) or TR Number
Taxpayer Name (If Unitary Business Group, Name of Designated Member)
Federal Employer Identification Number (FEIN) or TR Number
Unitary Business Groups Only: Name of Unitary Business Group Member Reporting on This Form
PART 1: SHAREHOLDERS AND OFFICERS.
See instructions.
1. A
B
C
D
E
F
G
Name of shareholder (including corporation, trust, or partnership),
FEIN or
Check
% Stock with
% Stock from Col. F less
officer, or family member receiving compensation from the
Member
Social Security number
(X) if an
% Stock
attribution
any attribution between
of shareholder or officer
officer
Number
business (Last, First, Middle)
directly owned
(See instructions.)
two active shareholders
%
%
%
%
%
%
%
%
%
%
%
%
%
%
%
%
%
%
%
%
%
%
%
%
%
%
%
%
%
%
%
%
%
%
%
%
%
%
%
%
%
%
%
%
%
%
%
%
Percent of stock (not listed above) owned by shareholders who own less than 10% and receive no compensation:
%
100
Total:
%
Continue below using the same Member Number references from column 1A.
H
I
J
K
L
M
N
Dividends
Total compensation and director
fees for officers and/or share-
Total shareholder/officer
(used to determine
Salaries, wages and/
Employee insurance
Share of business income/loss
Member
Number
active shareholders)
or director fees
plans, pensions, etc.
holders. Add columns J and K.
(See instructions.)
income. Add columns L and M.
If more space is needed, include additional 4577 forms. Identify taxpayer and complete Part 1 and Part 2 on each additional form. (See instructions.)
+
0000 2012 47 01 27 7
Continue on Page 2.

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