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Michigan Department of Treasury 
5680 (Rev. 12-21), Page 1 of 2 

2021 MICHIGAN Fiduciary Income Tax Beneficiary Information Continuation 
Schedule 
Issued under authority of Public Act 281 of 1967, as amended. 
Complete  this  form  if  you  have  more  than  four  (4)  beneficiaries.  This  is  a  continuation  of  the Michigan Fiduciary Income Tax  Return    
(Form MI-1041), Schedules 2, 3 and 4. 
Name of Estate or Trust                                                                    Federal Employer Identification Number (FEIN) 

SCHEDULE 2: BENEFICIARY IDENTIFICATION 
                        A                                                   B                                             C 
   Name and Residency Status                                                Address                                       Social Security number 
                  R= Resident                                 (Number, Street, Apt. #, City, State, ZIP Code)             or FEIN 
                 NR= Nonresident 

e. 

f. 

g. 

h. 

i. 

j. 

k. 

I. 

SCHEDULE 3: ALLOCATION OF NET MICHIGAN ADJUSTMENT FOR RESIDENT ESTATES OR TRUSTS 
                                                              A                                                B          C 
                                      Federal Distributable Net Income                                                    Allocation of Net 
                                                                                                               Percentage Michigan Adjustment 
   Beneficiary                                                                                                 of Amount  (Multiply amount on 
   Identification                                                                                              in         Form MI-1041 line 40 by 
   from                        Type of Income                   Location                                       Column A   percentage in
   Schedule 2     (Dividend, Interest, Rent, etc.)            (City, State)         Amount                                 Column B.) 

   e.                                                                                                             % 

   f.                                                                                                             % 

   g.                                                                                                             % 

   h.                                                                                                             % 

   i.                                                                                                             % 

   j.                                                                                                             % 

   k.                                                                                                             % 

   l.                                                                                                             % 

   Continue on page 2. If Schedule 4 does not apply, only submit page 1 of Form 5680 with your fiduciary return. 

5680, Page 2 of 2                                                                           . 

SCHEDULE 4: CAPITAL GAIN OR (LOSS) DISTRIBUTED TO BENEFICIARIES WHEN FORM MI-1041D IS FILED 
Beneficiary       A              B 
Identification 
from              Federal        Michigan 
Schedule 2        Gain or (Loss) Gain or (Loss) 
e. 

f. 

g. 

h. 

i. 

j. 

k. 

l.