Michigan Department of Treasury
4892 (Rev. 03-21), Page 1 of 3

2021 MICHIGAN Corporate Income Tax Amended Return
Issued under authority of Public Act 38 of 2011.
                                                                                                                   MM-DD-YYYY                                  MM-DD-YYYY

1.  Amended return is for calendar year 2021 or for tax year beginning:                                                          and ending:
2. Taxpayer Name (print or type)                                                                                   3. Federal Employer Identification Number (FEIN)

4. Street Address                                                                                                             Reason code for amending return (see instructions)

City                                                                                                               State      ZIP/Postal Code                  Country Code

5.  NAICS (North American Industry Classification System) Code 6. If a Final Return, Enter Effective End Date
                                                                                                                              8.                           Check if a special sourcing formula 
                                                               7b. Affiliated Group Election year (MM-DD-YYYY)                                             for transportation services is used in 
      Check if Filing Michigan Unitary Business Group Return. 
7a.   (Include Form 4896, if applicable, and Form 4897.)                                                                                                   the sourcing of Sales to Michigan.
  9.  Apportionment Calculation — If any amount in line 9a through 9e is zero, enter zero. All lines must be completed.
      a. Michigan sales of the corporation/Unitary Business Group (if no Michigan sales, enter zero)..................                                     9a.                               00
      b. Proportionate Michigan sales from unitary Flow-Through Entities (FTEs) (include Form 4900) ...............                                        9b.                               00
      c. Michigan sales. Add lines 9a and 9b .........................................................................................................     9c.                               00
      d. Total sales of the corporation/UBG ............................................................................................................   9d.                               00
      e. Proportionate total sales from unitary FTEs (include Form 4900) ...............................................................                   9e.                               00
      f. Total sales. Add lines 9d and 9e ................................................................................................................ 9f.                               00
      g. Apportionment percentage. Divide line 9c by line 9f .................................................................................             9g.                               %

10.   a. Gross receipts from corporate activities (see instructions) .......... 10a.                                             00
10.   b. Apportioned gross receipts from FTEs ........................................ 10b.                                      00
  11. REQUIRED: Total gross receipts for filing threshold purposes. Multiply line 10a by line 9g, and add line 10b ..                                      11.                               00

PART 1: CORPORATE INCOME TAX — See instructions.                                                                   A. As Originally Filed  
                                                                                                                   or Most Recently Amended                    B. Correct Amount
12.   Federal taxable income. (Amount includes agricultural activities.) ................ 12.                                                              00                                00
13.   Miscellaneous (see instructions) .................................................................. 13.                                              00                                00
14.   Adjustments due to decoupling of Michigan depreciation  
      from IRC § 168(k). If adjustment is negative, enter as negative:
      a. Net bonus depreciation adjustment ....................................................... 14a.                                                    00                                00
      b. Gain/loss adjustment on sale of eligible depreciable asset(s) ............... 14b.                                                                00                                00
      c.   Add lines 14a and 14b.  If negative, enter as negative.......................... 14c.                                                           00                                00
15.   Add lines 12, 13 and 14c. If negative, enter as negative .............................. 15.                                                          00                                00
16.   For a UBG, total group eliminations from business income (see 
      instructions). All other filers, enter zero. ....................................................... 16.                                             00                                00
17.   Business Income. Subtract line 16 from line 15.  
      If negative, enter as negative ....................................................................... 17.                                           00                                00
Additions to Business Income
18.   Interest income and dividends derived from obligations or securities of 
      states other than Michigan ............................................................................  18.                                         00                                00
19.   Taxes on or measured by net income including tax imposed under CIT ....... 19.                                                                       00                                00
20.   Any carryback or carryover of a federal net operating loss (enter as positive) .                         20.                                         00                                00
21.   Royalty, interest, and other expenses paid to a related person that is not a 
      UBG member of this taxpayer ............................................................................ 21.                                         00                                00
22.   Expenses from the production of oil and gas, and/or minerals (see instr.) .... 22.                                                                   00                                00
23.   Miscellaneous (see instructions)  .................................................................. 23.                                             00                                00
24.   Total Additions to Income.  Add lines 18 through 23 ..................................... 24.                                                        00                                00
25.   Corporate Income Tax Base After Additions.  Add lines 17 and 24.  
      If negative, enter as negative ....................................................................... 25.                                           00                                00

+ 0000 2021 14 01 27 7                                                                                                                                         Continue on Page 2

2021 Form 4892, Page 2 of 3                                                                                                 Taxpayer FEIN

PART 1: CORPORATE INCOME TAX (Continued)                                                                                   A. As Originally Filed  
Subtractions from Business Income                                                                                          or Most Recently Amended   B. Correct Amount
26.  Income from non-unitary FTEs (Enter loss as negative;  
     include Form 4898; see instructions) ............................................................. 26.                                        00                  00
27.  Dividends and royalties received from persons other than U.S. persons 
     and foreign operating entities ....................................................................... 27.                                    00                  00

28.  Interest income derived from United States obligations ..................................                         28.                         00                  00
29.  Income from the production of oil and gas, and/or minerals  
     (see instructions) .......................................................................................... 29.                             00                  00

30.  Miscellaneous (see instructions)  .....................................................................           30.                         00                  00

31.  Total Subtractions from Income.  Add lines 26 through 30 ............................                             31.                         00                  00
32.  Corporate Income Tax Base.  Subtract line 31 from line 25.   
     If negative, enter as negative ....................................................................... 32.                                    00                  00
33.  Apportioned Corporate Income Tax Base. Multiply line 32 by percentage 
     on line 9g ...................................................................................................... 33.                         00                  00
34.  Apportioned Income from non-unitary FTEs from Form 4898  
     (see instructions) .............................................................................................. 34.                         00                  00

35.  Total apportioned Corporate Income Tax Base. Add line 33 and line 34 .......                                      35.                         00                  00
36a. Available CIT business loss carryforward (see instructions). 
     Enter as positive ........................................................................................... 36a.                            00                  00
     Check if any loss on line 36a was acquired in this filing period in an 
36b. IRC 381(a)(1) or (2) transaction (see instructions)
37.  Subtract line 36a from line 35. If negative, enter here as negative. A 
     negative number here is the available business loss carryforward to the 
     next filing period (see instructions) ............................................................... 37.                                     00                  00
38.  Corporate Income Tax Before Credit. Multiply line 37 by 6% (0.06).  
     If less than zero, enter zero ............................................................................. 38.                               00                  00
PART 2: TOTAL CORPORATE INCOME TAX
39.  Small Business Alternative Credit (SBAC) from Form 4893, line 14 
     or line 18, whichever applies ........................................................................ 39.                                    00                  00
40.  Tax Liability after SBAC. Subtract line 39 from line 38. If less than or 
     equal to $100, enter zero. If apportioned or allocated gross receipts are 
     less than $350,000, enter zero (see instructions)......................................... 40.                                                00                  00

41.  Total Recapture of Certain Business Tax Credits from Form 4902 .................                                  41.                         00                  00

42.  Total Tax Liability. Add lines 40 and 41 .........................................................                42.                         00                  00
PART 3: PAYMENTS AND TAX DUE — UBGs include on lines 43 
through 46 payments from all members as reported on Form 4897.
43.  Overpayment credited from prior period return (MBT or CIT) .........................                              43.                         00                  00

44.  Estimated tax payments...................................................................................         44.                         00                  00

45.  Tax paid with request for extension .................................................................             45.                         00                  00

46.  Michigan tax withheld .......................................................................................     46.                         00                  00

47.  Amount paid with original return plus additional tax paid after original return was filed ..................................        47.                           00

48.  Payment total. Add line 43, column B, through line 46, column B, and line 47 ...............................................        48.                           00

49.  Overpayment, if any, received on the original return and/or amended return(s) .............................................         49.                           00

+ 0000 2021 14 02 27 5                                                                                                                                Continue and sign on Page 3

2021 Form 4892, Page 3 of 3                                                               Taxpayer FEIN

PART 3: PAYMENTS AND TAX DUE (Continued)                                                                                                                     B. Correct Amount

50.   Total payments available. Subtract line 49 from line 48 ..................................................................................         50.                  00

51.   TAX DUE. Subtract line 50 from line 42, column B. If less than zero, leave blank ..........................................                        51.                  00

52.   Underpaid estimate penalty and interest from Form 4899, line 38 ..................................................................                 52.                  00

53.   Annual Return Penalty (see instructions) ........................................................................................................  53.                  00

54.   Annual Return Interest (see instructions) ........................................................................................................ 54.                  00

55.   PAYMENT DUE.  If line 51 is blank, go to line 56. Otherwise, add lines 51 through 54 ..................................                            55.                  00

PART 4: REFUND OR CREDIT FORWARD
56.   Overpayment. Subtract lines 42, column B, and lines 52, 53 and 54 from line 50. 
      If less than zero, leave blank (see instructions)...............................................................................................   56.                  00

57.   CREDIT FORWARD. Amount on line 56 to be credited forward and used as an estimate for next CIT tax year .                                           57.                  00

58.   REFUND. Subtract line 57 from line 56 ...........................................................................................................  58.                  00

Taxpayer Certification.  I declare under penalty of perjury that the information in this Preparer Certification.  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

WITHOUT PAYMENT. Mail return to:                                         WITH PAYMENT. Pay amount on line 55. Mail check and return to:
  Michigan Department of Treasury                                           Michigan Department of Treasury, PO Box 30804, Lansing MI  48909
  PO Box 30803
  Lansing MI  48909                                                      Make check payable to “State of Michigan.” Print taxpayer’s FEIN, the tax year, 
                                                                         and “CIT” on the front of the check. Do not staple the check to the return.

+ 0000 2021 14 03 27 3

               Instructions for an amended Corporate Income Tax return
                                              Forms 4892, 4906 and 4909

Purpose                                                                         REASON CODE FOR AMENDING RETURN
                                                                                Include additional information on a separate sheet  
To calculate and file an amended Corporate Income Tax (CIT) 
                                                                                explaining the reason for amending the return.
return.
                                                                         01     Amended a federal return.
Standard  taxpayers  will  file  the CIT Amended Return  (Form 
4892);  insurance  companies  will  file  the Insurance Company          02     Federal audit.
Amended Return for Corporate Income and Retaliatory Taxes                03     Response to a Michigan Notice of Adjustment.
(Form 4906); and financial institutions will file CIT Amended            04     Claiming a previously unclaimed credit or payment.
Return for Financial Institutions (Form 4909).
                                                                         05     Original return missing information/incomplete 
                                                                                form.
Amending a Return
To amend a current or prior year annual return, use the amended          06     Correcting information/figures originally reported.
return that is applicable for that tax year and taxpayer type.           07     Unitary Business Groups:  
                                                                                Adding or deleting member(s).
Include  all  schedules  and  attachments  filed  with  the  original 
return, even if not amending them.   Do not  include a copy of           08     Due to litigation.
the original return with the amended return.                             20     Other.
Current and past year forms are available on Treasury’s Web              Amount paid with original return plus additional tax paid 
site at www.michigan.gov/treasuryforms.                                  after original return was filed: Enter all payments made with 
To amend a return to claim a refund, file within four years of           the  original  return  and  all  previous  returns  for  this  tax  year, 
the due date of the original return (including valid extensions).        as well as additional  payments made after those returns were 
Interest will be paid beginning 45 days after the claim is filed         filed. 
or the due date, whichever is later.                                     Overpayment, if any, received on the original return and/
If amending a return to report a deficiency, penalty and interest        or amended return(s): Enter the overpayment received (refund 
may apply from the due date of the original return.                      received plus credit forward created) on the original return and 
                                                                         all previous returns. 
If  any  changes  are  made  to  a  federal  income  tax  return  that 
affect CIT tax base, filing an amended return is  required. To           Standard Taxpayers Only
avoid penalty, file the amended return within 120 days after the 
                                                                         “As Originally Filed or  Most Recently Amended” and 
final determination by the Internal Revenue Service.
                                                                         “Correct  Amount”:  Where  the  amended  return  provides 
                                                                         a  Column  A  titled  “As  Originally  Filed  or  Most  Recently 
Line-by-Line Instructions
                                                                         Amended,” provide the amount that was used on the taxpayer’s 
In most cases, the lines on the amended return match the lines           most  recent  return  that  the  new  return  will  amend.  Put  the 
on the originally filed return. Unless otherwise noted, use the          amended amounts in Column B, “Correct Amount.”
instructions  for  the  original  return  to  complete  the  amended 
return.  Follow  the  instructions  for  the  CIT Annual  Return         NOTE:  On  lines  9  through  11,  complete  only  with  amended 
(Form  4891)  to  complete  Form  4892;  follow  the  instructions       numbers.
for  the Insurance Company Annual Return for Corporate 
                                                                         Insurance Companies and Financial Instituions
Income and Retaliatory Taxes (Form 4905) to complete Form 
4906; and follow the instructions for the CIT Annual Return for          Insurance  Companies  will  complete  all  lines  of  an  amended 
Financial Institutions (Form 4908) to complete Form 4909.                return using  only  amended  numbers.  Financial  filers  will 
                                                                         complete an amended return with entries for both the original 
Federal  Employer  Identification  Number  (FEIN):  The 
                                                                         and  amended  figures  as  directed.  Taxpayers  must  file  using 
taxpayer FEIN from the top of page one must be repeated in 
                                                                         the appropriate amended return.
the space provided at the top of each succeeding page of the 
amended form.
Reason code for amending return: Using the following table, 
select  the  two-digit  code  that  best  represents  the  reason  for 
amending the return. Enter the code in the appropriate field in 
the taxpayer information at the top of page 1. Include additional 
explanation  on  a  separate  sheet  of  paper  and  attach  it  to  the 
amended return.

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