Form 4917 Flow-Through Withholding (FTW) Quarterly Return

Form 4917
Flow-Through Withholding (FTW) Quarterly Return
Complete voucher at bottom of the page, cut at dotted line, and 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.”
Reset Form
Michigan Department of Treasury
4917 (Rev. 04-14)
Due Date (MM-DD-YYYY)
2015 MICHIGAN Flow-Through Withholding Quarterly Return
Quarter Ending Date (MM-DD-YYYY)
Issued under authority of Public Act 38 of 2011. See instructions for filing guidelines.
Name
Street Address
City
State
ZIP/Postal Code
FEIN/Account Number
Organization Type Code (see instr.)
1. Non-resident Individual
Flow-Through Withholding... 1.
00
2. Corporate Flow-Through
Withholding......................... 2.
00
3. Penalty and Interest........... 3.
00
4. Total Payment..................... 4.
00
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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