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Get MI DoT 4917 2014

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, Lan.

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