Michigan Department of Treasury
4567 (Rev. 04-21), Page 1 of 3                                                                                                                                                Check if this is an 
                                                                                                                                                                              amended return.
2021 MICHIGAN Business Tax Annual Return                                                                                                                                      See instructions.
Issued under authority of Public Act 36 of 2007.                                                                  MM-DD-YYYY                                                  MM-DD-YYYY

1.  Return is for calendar year 2021 or for tax year beginning:                                                                                         and ending:
2.  Taxpayer Name (print or type)                                                                                7. )HGHUDO (PSOR\HU ,GHQWL¿FDWLRQ 1XPEHU  )(,1  RU 75 1XPEHU

Doing Business As (DBA)                                                                                          8. Organization Type (LLC or Trust, see instructions)

Street Address                                                                Check if                                       Individual                                       C Corporation / 
                                                                                                                                                                              LLC C Corporation
                                                                              new address.  
                                                                              (See instructions)
City                             State                        ZIP/Postal Code  Country Code                                  Fiduciary                                        S Corporation /
                                                                                                                                                                              LLC S Corporation
3. Principal Business Activity                                4. Business Start Date in Michigan
                                                                                                                             Partnership / LLC Partnership

5.  NAICS (1RUWK $PHULFDQ ,QGXVWU\ &ODVVL¿FDWLRQ 6\VWHP  Code    ,I 'LVFRQWLQXHG  (ႇHFWLYH 'DWH                  9.          Check if Filing Michigan Unitary Business Group Return.
                                                                                                                             (Include Form 4580.)
                                                                                                                 10.         Check if line 11 includes sales of transportation services.

11.   Apportionment Calculation
      a. Michigan Sales (if no Michigan sales, enter zero) .................................................................                       11a.                                           00
      b. Total Sales ............................................................................................................................. 11b.                                           00
      c. Apportionment Percentage. Divide line 11a by line 11b ........................................................                            11c.                                           %

PART 1:  MODIFIED GROSS RECEIPTS TAX
  12. Gross Receipts (see instructions)......................................................................................................................             12.                     00
Subtractions from Gross Receipts
  13. Inventory acquired during the tax year ..............................................................................................................               13.                     00
  14. Depreciable assets acquired during the tax year ..............................................................................................                      14.                     00
  15. Materials and supplies not included in inventory or depreciable property .........................................................                                  15.                     00
  16. 6WDႈQJ &RPSDQ\  &RPSHQVDWLRQ RI SHUVRQQHO VXSSOLHG WR FXVWRPHUV ............................................................                                        16.                     00
If claiming the Small Business Alternative Credit, skip to line 18.
  17. Deduction for contractors in SIC Codes 15, 16 and 17 .....................................................................................                          17.                     00
      SIC Code:
  18. )LOP UHQWDO RU UR\DOW\ SD\PHQWV SDLG E\ D WKHDWHU RZQHU WR D ¿OP GLVWULEXWRU DQG RU ¿OP SURGXFHU ...................                                                18.                     00
  19. 4XDOL¿HG $ႇRUGDEOH +RXVLQJ 3URMHFW  4$+3  'HGXFWLRQ
      a. Gross receipts attributable to residential rentals in Michigan ........... 19a.                                                                00
      b. Number of residential rent restricted units in Michigan owned  
           E\ WKH 4$+3 ..................................................................................... 19b.
      c.   7RWDO QXPEHU RI UHVLGHQWLDO UHQWDO XQLWV LQ 0, RZQHG E\ WKH 4$+3 .. 19c.
      d. Divide line 19b by line 19c and enter as a percentage  .................... 19d.                                                               %
      e. Multiply line 19a by line 19d ............................................................. 19e.                                               00
      f.   /LPLWHG GLYLGHQGV RU RWKHU GLVWULEXWLRQV PDGH WR RZQHUV RI WKH 4$+3 19f.                                                                     00
      g.   4$+3 'HGXFWLRQ  6XEWUDFW OLQH   I IURP OLQH   H ....................................................................................... 19g.                                           00
  20. Payments made by taxpayers licensed under Article 25 or Article 26 of the Occupational Code 
      to independent contractors licensed under Article 25 or Article 26 ....................................................................                             20.                     00
  21. Miscellaneous (see instructions) .......................................................................................................................            21.                     00
  22. Total Subtractions from Gross Receipts. Add lines 13 through 18 and 19g through 21 ....................................                                             22.                     00
  23. 0RGL¿HG *URVV 5HFHLSWV  6XEWUDFW OLQH    IURP OLQH     ,I OHVV WKDQ ]HUR  HQWHU ]HUR .......................................                                        23.                     00
  24. $SSRUWLRQHG 0RGL¿HG *URVV 5HFHLSWV 7D[ %DVH  0XOWLSO\ OLQH  3 by percentage on line 11c ...........................                                                 24.                     00
  25. Multiply line 24 by 0.8% (0.008) .......................................................................................................................            25.                     00
  26. Enrichment Prohibition for dealers of personal watercraft or new motor vehicles. Enter amount collected 
      during tax year ................................................................................................................................................... 26.                     00
  27. 0RGL¿HG *URVV 5HFHLSWV 7D[ %HIRUH $OO &UHGLWV   Enter the greater of line 25 or line 26 .............................                                               27.                     00

+ 0000 2021 11 01 27 3                                                                                                                                                        Continue on Page 2

2021 Form 4567, Page 2 of 3                                                                                      FEIN or TR Number

PART 2: BUSINESS INCOME TAX

28. Business Income. If negative, enter as negative. (If business activity protected under PL 86-272, complete 
    and attach Form 4586 and/or 4581, as applicable; see instructions) ................................................................                        28.  00

Additions to Income
29. Interest income and dividends derived from obligations or securities of states other than Michigan .................                                       29.  00
30. Taxes on or measured by net income ................................................................................................................        30.  00
31. Tax imposed under MBT .................................................................................................................................... 31.  00
32. Any carryback or carryover of a federal net operating loss ................................................................................                32.  00
33. /RVVHV DWWULEXWDEOH WR RWKHU ÀRZ WKURXJK HQWLWLHV WKDW DUH WD[HG XQGHU WKH 0%7 ...............................................                             33.  00
    Account No.
34. Royalty, interest, and other expenses paid to a related person ..........................................................................                  34.  00
35. Miscellaneous (see instructions)  .......................................................................................................................  35.  00
36. Total Additions to Income.  Add lines 29 through 35...........................................................................................             36.  00
37. Business Income Tax Base After Additions.  Add lines 28 and 36.  If negative, enter as negative ..............                                             37.  00

Subtractions from Income
38. Dividends and royalties received from persons other than U.S. persons and foreign operating entities ..........                                            38.  00
39. ,QFRPH DWWULEXWDEOH WR RWKHU ÀRZ WKURXJK HQWLWLHV WKDW DUH WD[HG XQGHU WKH 0%7 ..............................................                              39.  00
    Account No.
40. Interest income derived from United States obligations ....................................................................................                40.  00
41. Net earnings from self-employment.  If less than zero, enter zero ....................................................................                     41.  00
42. Miscellaneous (see instructions)  .......................................................................................................................  42.  00
43. Total Subtractions from Income.  Add lines 38 through 42 ................................................................................                  43.  00

44. Business Income Tax Base. Subtract line 43 from line 37. If negative, enter as negative .....................................                              44.  00
45. Apportioned Business Income Tax Base. Multiply line 44 by percentage on line 11c .......................................                                   45.  00
46. Available MBT business loss carryforward from previous MBT return. Enter as a positive number..................                                            46.  00
47. Subtract line 46 from line 45. If negative, enter here as negative, skip line 48, and enter zero on line 49. A 
    QHJDWLYH QXPEHU KHUH LV WKH DYDLODEOH EXVLQHVV ORVV FDUU\IRUZDUG WR WKH QH[W 0%7 ¿OLQJ SHULRG  VHH LQVWU   .....                                           47.  00

48. 4XDOL¿HG $ႇRUGDEOH +RXVLQJ 'HGXFWLRQ  ,I OLQH    LV SRVLWLYH  FRPSOHWH OLQHV   D WKURXJK   L DV IROORZV 
        ,I WDNLQJ WKH 4$+3 GHGXFWLRQ RQO\  FRPSOHWH OLQHV   D WKURXJK   L   8%*V  VHH LQVWUXFWLRQV       ,I 
    taking the seller’s deduction only, skip lines 48a through 48h and carry the amount from Form 4579, line 
       WR OLQH   L      ,I WDNLQJ ERWK GHGXFWLRQV  FRPSOHWH WKH 4$+3 GHGXFWLRQ FDOFXODWLRQ RQ OLQHV   D WKURXJK 
    48h, and add to the total at line 48i the amount from Form 4579, line 5.
    a. Gross rental receipts attributable to residential units in  
       Michigan ........................................................................................... 48a.                  00
    b. Rental expenses attributable to residential rental units in Michigan ... 48b.                                              00
    c. Taxable income attributable to residential rental units. Subtract line 
       48b from line 48a .............................................................................. 48c.                      00
    d. Number of residential rent restricted units in Michigan owned by 
       WKH 4XDOL¿HG $ႇRUGDEOH +RXVLQJ 3URMHFW .......................................... 48d.
    e. Total number of residential rental units in Michigan owned by the 
       4XDOL¿HG $ႇRUGDEOH +RXVLQJ 3URMHFW ................................................ 48e.
    f. Divide line 48d by line 48e and enter as a percentage..................... 48f.                                            %
    g. Multiply line 48c by line 48f............................................................... 48g.                          00
    h. Limited dividends or other distributions made to the owners of  
       WKH 4$+3 ......................................................................................... 48h.                    00
    i. 4XDOL¿HG $ႇRUGDEOH +RXVLQJ 'HGXFWLRQ  6XEWUDFW OLQH   K IURP OLQH   J   6HH LQVWUXFWLRQV   ....................                                         48i. 00
49. Subtract line 48i from line 47. If less than zero, enter zero ...............................................................................              49.  00
50. Business Income Tax Before All Credits. Multiply line 49 by 4.95% (0.0495).......................................................                          50.  00

+ 0000 2021 11 02 27 1                                                                                                                                              Continue and sign on Page 3

2021 Form 4567, Page 3 of 3                                                                   FEIN or TR Number

PART 3: TOTAL MICHIGAN BUSINESS TAX 
51.   Total Michigan Business Tax Before Credits.  Add lines 27 and 50 .............................................................                              51.                    00
52.   The annual surcharge is no longer applicable. There is no amount to be entered on this line .........................                                       52.  X X X X X X X X X 00

53.   Enter amount from line 51. If apportioned or allocated gross receipts are less than $350,000, enter zero ......                                             53.                    00
54.   Nonrefundable credits from Form 4568, line 40 ................................................................................................              54.                    00
55.   Total Tax After Nonrefundable Credits.  Subtract line 54 from line 53. If less than zero, enter zero .............                                          55.                    00
56.   Recapture of Certain Business Tax Credits and Deductions from Form 4587, line 13 ......................................                                     56.                    00
57.   Total MBT Tax Liability. Add lines 55 and 56...................................................................................................             57.                    00
58.   &RUSRUDWH ,QFRPH 7D[ DGMXVWPHQW IURP )RUP       OLQH    .............................................................................                       58.                    00
59.   Total Tax Liability. Add lines 57 and 58 ...........................................................................................................        59.                    00

PART 4: PAYMENTS, REFUNDABLE CREDITS AND TAX DUE
60.   Overpayment credited from prior MBT return ....................................................................................................             60.                    00
61.   Estimated tax payments .................................................................................................................................... 61.                    00
62.   There is no amount to be entered on this line. Skip to line 63...........................................................................                   62.  X X X X X X X X X 00
63.   Tax paid with request for extension ...................................................................................................................     63.                    00
64.   Refundable credits from Form 4574, line 23 .....................................................................................................            64.                    00
65.   Payment and credit total.  Add lines 60 through 64. (If not amending, then skip to line 67.) .............................                                  65.                    00
                a. Payments made with original and/or amended returns                   66a.                        00
      AMENDED 
66.   RETURN    b. Overpayment from original and/or amended returns .                   66b.                        00
      ONLY      c. Add lines 65 and 66a and subtract line 66b
                   from the sum.............................................................. ........................................................            66c.                   00
67.   TAX DUE. Subtract line 65 (or line 66c, if amending) from line 59. If less than zero, leave blank ....................                                      67.                    00
68.   Underpaid estimate penalty and interest from Form 4582, line 38 ....................................................................                        68.                    00

69.   Annual return penalty (a)          %=   (b)                        00 plus interest (c)   00 .  Total ...... 69d.                                                                  00
70.   PAYMENT DUE.  If line 67 is blank, go to line 71. Otherwise, add lines 67, 68 and 69d ..................................                                    70.                    00

PART 5: REFUND OR CREDIT FORWARD
71.   Overpayment. Subtract lines 59, 68 and 69d from line 65 (or line 66c, if amending). 
      If less than zero, leave blank (see instructions) .................................................................................................         71.                    00
72.   CREDIT FORWARD. Amount on line 71 to be credited forward and used as an estimate for next tax year ....                                                     72.                    00
73.   REFUND. Amount on line 71 to be refunded.....................................................................................................               73.                    00

7D[SD\HU &HUWL¿FDWLRQ   I declare under penalty of perjury that the information in this 3UHSDUHU &HUWL¿FDWLRQ   I declare under penalty of perjury that this
return and attachments is true and complete to the best of my knowledge.                return is based on all information of which I have any knowledge.
                                                                                        Preparer’s PTIN, FEIN or SSN
      By checking this box, I authorize Treasury to discuss my return with my preparer.
Authorized Signature for Tax Matters                                                    Preparer’s Business Name (print or type)

Authorized Signer’s Name (print or type)               Date                             Preparer’s Business Address and Telephone Number (print or type)

Title                                    Telephone Number

                Return is due April 30 or on or before the last day of the 4th month after the close of the tax year.
WITHOUT PAYMENT. Mail return to:                                            WITH PAYMENT. Pay amount on line 70. Mail check and return to:
  Michigan Department of Treasury, PO Box 30783, Lansing MI  48909             Michigan Department of Treasury, PO Box 30113, Lansing MI  48909
                                                                            Make check payable to “State of Michigan.” Print taxpayer’s FEIN or TR 
                                                                            Number, the tax year, and “MBT” on the front of the check. Do not staple the 
                                                                            check to the return.

+ 0000 2021 11 03 27 9

                                            Instructions for Form 4567 
                          Michigan Business Tax (MBT) Annual Return

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