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Form 4917 2016
4.
00
City
State
ZIP/Postal Code
FEIN/Account Number
Organization Type Code (see instr.)
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.”
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9999 2012 02 01 27 7
Michigan Department of Treasury
4917 (Rev. 11-11)
Due Date (MM-DD-YYYY)
2012 MICHIGAN Flow-Through Withholding Quarterly Return
Quarter Ending Date (MM-DD-YYYY)
Issued under authority of Public Act 38 of...
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