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Get MI DoT 3683 2009-2021

Michigan Department of Treasury 3683 Rev. 8-09 Reset Form Payroll Service Provider Combined Power of Attorney Authorization and Corporate Officer Liability COL Certificate for Businesses Issued under authority of the Revenue Act P. A. 122 of 1941 as amended* Filing is voluntary. Complete this form if you wish to appoint someone to represent your business to the State of Michigan for withholding tax matters. Taxpayer Name Account No*/Federal Employer ID No* FEIN Address Street or RR City State ZI.

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