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    Michigan Department of Treasury
    165 (Rev. 7-08)                                                                                                                                           Amended Return
    Annual Return for Sales, Use and Withholding Taxes                                                                                                       Amendment Date
    Taxpayer Name                                        Account Number

                                                         Return Year                                                         Date Due                       File this return
                                                                                                                                                            by February 28.
    Do not use this form to replace a monthly or quarterly return.

                                                                                                                    A. Use Tax: Sales & Rentals                   B.  Sales Tax

    Sales and Use Tax                                                                                                                 6%                          6%

    1.  Gross sales (including sales by out-of-state vendors subject to use tax)..1.                                                                       1.
    2.  Rentals of tangible property and accommodations ....................................2.                                                             2.
    3.  Communication services.............................................................................3.                                              3.
    4.  Add lines 1, 2, and 3..................................................................................... .4                                      4.
        ALLOWABLE DEDUCTIONS
(i) 5a. Resale.......................................................................................................... 5a.                   5a.
(i) b.  Industrial processing or agricultural producing ..........................................b.                                                       b.
(i) c.  Interstate commerce....................................................................................c.                                          c.
(i) d.  Exempt services...........................................................................................d.                                       d.
(i) e.  Sales on which tax was paid to Secretary of State.......................................e.                                                         e.
(i) f.  Food for human/home consumption........................................................... .f                                                      f.
(i) g.  Bad debts .....................................................................................................g.                                  g.
(i) h.  Michigan motor fuel or diesel fuel tax ..........................................................h.                                                h.
(i) i.  Other. Identify: ____________________________.................................... i.                                                               i.
(i) j.  Tax included in gross sales (line 1)............................................................. j.                                               j.
    k.  Total allowable deductions. Add lines 5a - 5j .............................................. .k                                                    k.
    6.  Taxable balance. Subtract line 5k from line 4.............................................. .6                                                     6.
    7.  Tax Rate........................................................................................................7.               x .06             7.              x .06
    8.  Gross tax due. Multiply line 6 by line 7......................................................... .8                                               8.
(i) 9.  Tax collected in excess of line 8................................................................... .9                                            9.
    10. Add lines 8 and 9.......................................................................................... 10.                        10.
(i) 11. TOTAL discount allowed (see instructions) .............................................. 11.                                           11           .
    12. Total tax due. Subtract line 11 from line 10 .................................................. 12.                                    12.
(i) 13. Tax payments in current year (after discounts)............................................ .13                                         13.

    Use Tax on Items Purchased for Business or Personal Use (see back)*
(i) 14. Enter your purchases taxable at the 6% rate.................................. 14a.                                               x .06=               14b.
(i) 15. Tax payments made in the current year.............................................................................................................    15.

    Withholding Tax
(i) 16. Gross Michigan payroll and other taxable compensation for the year.............................................................                       16.
(i) 17. Number of W-2s, 1099s, and/or 4119 Forms enclosed................. 17.
(i) 18. Total Michigan income tax withheld per W-2s, 1099s and 4119 Forms ..........................................................                          18.
    19. Total Michigan income tax withholding paid during current tax year ................................................................                   19.

    Summary
    20. Total sales, use and withholding taxes due. Add lines 12A, 12B, 14b and 18 ................................................                           20.
    21. Total sales, use and withholding taxes paid. Add lines 13A, 13B, 15 and 19..................................................                          21.
    22. If line 21 is greater than line 20, enter overpayment.......................      22.
    23. Amount of line 22 to be credited to your account.
        We will notify you when your credit is verified and available...........          23.
(i) 24. Amount of line 22 to be refunded to you ......................................... 24.
(i) 25. If line 21 is less than line 20, enter balance due..............................................................................................      25.
(i) 26. If this return is filed late, enter penalty and interest. (See instructions.) ..........................................................              26.
    27. TOTAL PAYMENT DUE. Add lines 25 and 26. Make check payable to "State of Michigan."...........................                                         27.

                                                                                                                                      Complete and sign the back of this return.

Form 165, Page 2
                                                            Account Name                                          Account Number

Type of Business Ownership (check one only)

Individual                                                               Michigan Corporation      Trust or Estate (Fiduciary)
Husband - Wife                                                               Subchapter S          Joint Stock Club or Investment Company
Partnership                                                                  Professional          Social Club or Fraternal Organization
Registered Partnership, Agreement Date:                                                            Other (Explain)
Limited Partnership                                                      Non-Mich. Corporation
                                                                             Subchapter S
Limited Liability Company
Domestic (Michigan)
Professional
Foreign (Non-Michigan)

Reason for Amending Return. Include your account number in the explanation.

Signature (you are required to complete all information requested below)
I declare under penalty of perjury that this return is true and complete to     I declare under penalty of perjury that this return is based
the best of my knowledge.                                                       on all information of which I have any knowledge.
I authorize Treasury to discuss my return with my preparer.              Yes No Preparer's Signature, Address, Telephone and Preparer's ID Number

Taxpayer's Signature

Taxpayer's Social Security Number                       Telephone Number
                                                        (               )
Taxpayer's Title (Owner/Officer/Member/Manager/Partner) Date

Print Name of Corporate Officer Responsible for Return  Telephone Number
                                                        (               )

Be Aware of Recent Changes in Postal Regulations When Mailing Your Tax Return
Effective May 2007, the U.S. Post Office calculates postage based on the weight, size and thickness of an envelope. Consult
with the Post Office before mailing to avoid delays in delivery; items with insufficient postage will be returned to the sender by
the Post Office.

If you are enclosing payment with your return:                                            If you are not enclosing payment:
MAIL TO:   Michigan Department of Treasury                                                MAIL TO: Michigan Department of Treasury
           Department 78172                                                                        Lansing, MI  48930
           P.O. Box 78000
           Detroit, MI  48278-0172

*Use Tax on Items Purchased for Business or Personal Use
Use lines 14 and 15 to report purchases made for use in your business or for items removed from your inventory for personal or
business use. Do not repeat the amounts from Column A, lines 1 - 4 here.

                    To check your Sales, Use and Withholding transactions and ask questions about
                                  your account on-line, visit  www.michigan.gov/businesstax