Michigan Department of Treasury                                                                                                                                                                                                    Account Number                                                                           Return Year
3861 (Rev. 08-12)

Annual Return Worksheet
                                                                                                                                                                                                                                      A. Use Tax on Sales                                                                   B. Sales Tax
Sales and Use Tax                                                                                                                                                                                                                                 and Rentals
1. Gross sales (including sales by out-of-state vendors subject to use tax) .......                                                                                                                                                1.
2. Rentals of tangible property and/or accommodations ....................................                                                                                                                                         2.
3. Telecommunications services .........................................................................                                                                                                                           3.
4. Add lines 1, 2 and 3. .......................................................................................                                                                                                                   4.
5.  Allowable Deductions
a. Resale ............................................................................................................                                                                                                             5a.
b. Industrial processing or agricultural producing ...............................................                                                                                                                                 b.
c. Interstate commerce .......................................................................................                                                                                                                     c.
d. Exempt services .............................................................................................                                                                                                                   d.
e. Sales on which tax was paid to Secretary of State.........................................                                                                                                                                      e.
f. Food for human/home consumption ...............................................................                                                                                                                                 f.
g. Bad debts .......................................................................................................                                                                                                               g.
h. Michigan motor fuel or diesel fuel tax .............................................................                                                                                                                            h.
i. Other. Identify:                                                                                                                                                                                                                i.
j. Tax included in gross sales (line 1).................................................................                                                                                                                           j.
k. Total allowable deductions. Add lines 5a - 5j. .................................................                                                                                                                                k.
6. Taxable balance. Subtract line 5k from line 4. ................................................                                                                                                                                 6.
7. Tax. Multiply line 6 by the rate given...............................................................                                                                                                                           7.                                                                                x .06              x .06
8. Gross tax due before discount........................................................................                                                                                                                           8.
9. Tax collected in excess of line 8. ....................................................................                                                                                                                         9.
10. Add lines 8 and 9. ...........................................................................................                                                                                                                 10.
11. Total discount allowed ....................................................................................                                                                                                                    11.
12. Total tax due. Subtract line 11 from line 10. ....................................................                                                                                                                             12.
13. Tax payments made in current year (after discounts).....................................                                                                                                                                       13.
Use Tax on Items Purchased for Business or Personal Use *
14. Enter your taxable purchases..............................................                                                                                                                                                14a.                x .06.06=x .0614b.14b.4b=
15. Tax payments made in the current year ......................................................................................................................................................................................................                                                                     151515.
Withholding Tax
                                                                                                                                                                                                                                                          DDDD
16. Gross Michigan payroll, pension, and other taxable compensation for the year. ...........................................ensation for the year. ......................ensation for the year. .....................                                                                                               16.
                                                                                                                                                                                                                                                  NN
17. Number of W-2 and/or 1099 forms enclosed withth youryourannualannual return  1717th7..your________________________.______annual return                                                                                                          _______
                                                                                                                                                                                                                                      ENENEN
18. Total Michigan income tax withheld perer W-2sW-2s............................................................................................................................er W-2s18.                                                                                                                                 ..........................................
19. Total Michigan income tax withholdingholding paidpaidduringduringcurrentcurrenttaxtaxyeyear ...............................................................withholding19.                                                                                                                                               paid during current tax yea
Summary
20. Total sales, usee andandwithholdingwithholdingtaxestaxesdue.due.AAdd lines 12A, 12B, 14b and 18. ................................................es,20.use and withholding taxes due. Ad
21. Totaltal sales,sales,useuseandandwithholdingwithholdingtaxtaxes paid during current tax year. Add lines 13A, 13B, 15 and 19 .............tal21.sales, use and withholding taxe
22. If linee2121isisgreatergreaterthanthanlineli                                                                                                                                   20, entere overpayment21 is greater ......................................................................................than lin22.
23. Amountuntofoflineline22 to be credited to your account. Treasury will notify you when your credit is verifi ed and unt of line 22 
    available.. ........................................................................................................................................................ble..ble..                                                                                                                                   23.
             DO NOT SEND
24. Amount of line 22 to be refunded to you ........................................................................................................                                                                                                                                                                 24.
25. If line 21 is less than line 20, enter balance due. ...........................................................................................                                                                                                                                                                  25.
26. If this return is fi led late, enter penalty and interest (See instructions)                                                                                                                                                                                                                                      26.
27. TOTAL PAYMENT DUE.  Add lines 25 and 26. Enter here and on the return.                                                                                                                                                                                                                                           27.
IMPORTANT:  This worksheet is your fi le copy and may be subject to audit.  DO NOT SEND. Record your account number and your return year in 
the upper right corner.  Keep this for your records.To check your Sales, Use and Withholding transactions and ask questions about your account, visit 
Treasury’s Web site at www.michigan.gov/businesstax.
* Use Tax on Items Purchased for Business or Personal Use. Use lines 14 and 15 to report purchases made for use in your buiness or for items 
removed from your inventory for personal or business use. Do not repeat the amounts from Column A, lines 1 - 4 here.