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Michigan Department of Treasury 
3820 (Rev. 03-21) 
                                                                                                               Schedule CR-5 

2021 MICHIGAN Schedule of Taxes and Allocation to Each Agreement 
Issued under authority of Public Act 281 of 1967, as amended. 

Include with Form MI-1040. Type or print in blue or black ink.                                                             Attachment 04 
1. Filer’s First Name                    M.I.    Last Name                                       2. Filer’s Full Social Security No. (Example: 123-45-6789) 

If a Joint Return, Spouse’s First Name   M.I.    Last Name                                       Spouse’s Full Social Security No. (Example: 123-45-6789) 

INSTRUCTIONS:         Complete Columns A through H.  

                      A                                       B       C        D                 E   F         G           H 
                                                                               See Instructions                            Allocated Tax 
                  Agreement Number                                    Check if                                 Divide Each Credit. Multiply 
County                             Expiration Date                    2020 or                                  Amount in   MI-1040CR-5 
Code   Contract Number  (Enter as MM-DD-YYYY)                 2021    2021                                     Column F by Line 15 or 20 
                                                              Total   Property  Type of Percent of   Total Tax Total on    by Percent 
                      EXAMPLE:                                Taxable Taxes  Owner-     Income or    for Each  Line 3,     Computed in 
01          98765               12     - 31  -   2060         Value   Are Paid ship     Ownership    Agreement Column F    Column G 

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     Check here if additional page(s) used.  Enter total from additional page(s), if applicable. 
                                                                                                                       % 
3.   Enter total of columns F through H (total of column G must equal 100%).  Carry total from 
     column F to your MI-1040CR-5,       line 4.                                                                       % 

+ 0000 2021 21 01 27 2