V.1.2 10/1/2021
                                                 to JPMC 10/1/2021

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Michigan Department of Treasury (Rev. 11-21), Page 1 of 2                                                          Issued under authority of Public Act 281 of 1967, as amended.

2021 MICHIGAN Individual Income Tax Return MI-1040                                                                                                               Amended Return
                                                                                                                                                                 (Include Schedule AMD)
Return is due April 18, 2022. Type or print in blue or black ink.
1. Filer’s First Name                     M.I.   Last Name                                                         2. Filer’s Full Social Security No. (Example: 123-45-6789)

If a Joint Return, Spouse’s First Name    M.I.   Last Name
                                                                                                                   3. Spouse’s Full Social Security No. (Example: 123-45-6789)
Home Address (Number, Street, or P.O. Box)

City or Town                                                 State                             ZIP Code            4. School District Code (5 digits – see page 60)

5.  STATE CAMPAIGN FUND                                                                                 6. FARMERS, FISHERMEN, OR SEAFARERS 
    Check if you (and/or your spouse, if                  a. Filer
    filing a joint return) want $3 of your taxes                                                               Check this box if 2/3 of your income is from farming, 
    to go to this fund. This will not increase            b. Spouse                                            fishing, or seafaring.
    your tax or reduce your refund.

7.  2021 FILING STATUS. Check one.                                                                      8. 2021 RESIDENCY STATUS. Check all that apply.
a.      Single                            * If you check box “c,” complete                              a.     Resident
                                          line 3 and enter spouse’s full name                                                                                        * If you check box “b” or 
b.      Married filing jointly            below:                                                        b.     Nonresident *                                         “c,” you must complete 
                                                                                                                                                                     and include Schedule 
                                                                                                                                                                     NR.
c.      Married filing separately*                                                                      c.     Part-Year Resident *

9.  EXEMPTIONS. NOTE: If someone else can claim you as a dependent, check box 9e, enter 0 on line 9a and enter $1,500 on line 9e (see instr.).

    a. Number of exemptions (see instructions) .............................................................   9a.     x                                  $4,900 9a.                           00
    b. Number of individuals who qualify for one of the following special exemptions: deaf, 
       blind, hemiplegic, paraplegic, quadriplegic, or totally and permanently disabled                        9b.     x                                  $2,800 9b.                           00
    c. Number of qualified disabled veterans ................................................................. 9c.     x                                  $400   9c.                           00
    d. Number of Certificates of Stillbirth from MDHHS (see instructions) .....................                9d.     x                                  $4,900 9d.                           00

    e. Claimed as dependent, see line 9 NOTE above ..................................................          9e.                                               9e.                           00

    f. Add lines 9a, 9b, 9c, 9d and 9e.  Enter here and on line 15 .............................................................................                 9f.                           00

10. Adjusted Gross Income from your U.S. Form 1040 (see instructions) ....................................................                                10.                                  00

11. Additions from Schedule 1, line 9. Include Schedule 1 ............................................................................                    11.                                  00

12. Total. Add lines 10 and 11 .......................................................................................................................... 12.                                  00

13. Subtractions from Schedule 1, line 29.  Include Schedule 1 ....................................................................                       13.                                  00

14. Income subject to tax. Subtract line 13 from line 12.  If line 13 is greater than line 12, enter “0” ............                                     14.                                  00

15. Exemption allowance. Enter amount from line 9f or Schedule NR, line 19..............................................                                  15.                                  00

16. Taxable income. Subtract line 15 from line 14.  If line 15 is greater than line 14, enter “0” ......................                                  16.                                  00

17. Tax. Multiply line 16 by 4.25% (0.0425) .....................................................................................................         17.                                  00
NON-REFUNDABLE CREDITS                                                                                  AMOUNT                                                           CREDIT
18. Income Tax Imposed by government units outside Michigan. 
    Include a copy of the return (see instructions)........................                    18a.                    00                                 18b.                                 00
19. Michigan Historic Preservation Tax Credit carryforward (see 
    instructions) ............................................................................ 19a.                    00                                 19b.                                 00
20. Income Tax. Subtract the sum of lines 18b and 19b from line 17. 
    If the sum of lines 18b and 19b is greater than line 17, enter “0” ...............................................................                    20.                                  00

+ 0000 2021 05 01 27 6                                    Continue on page 2. This form cannot be processed if page 2 is not completed and included.

2021 MI-1040, Page 2 of 2
                                                                 Filer’s Full Social Security Number
21.   Enter amount of Income Tax from line 20. ..................................................................................................        21.                      00
22.   Voluntary Contributions from Form 4642, line 6. Include Form 4642........................................................                          22.                      00
23.   USE TAX. Use tax due on Internet, mail order or other out-of-state purchases from 
      Worksheet 1 (see instructions) ................................................................................................................... 23.                      00

24.   Total Tax Liability. Add lines 21, 22 and 23 ................................................................................... 24.                                        00
REFUNDABLE CREDITS AND PAYMENTS

25.   Property Tax Credit. Include MI-1040CR or MI-1040CR-2 .....................................................................                        25.                      00

26.   Farmland Preservation Tax Credit.          Include MI-1040CR-5 .....................................................................               26.                      00
                                                                                                 FEDERAL                                                       MICHIGAN
27.   Earned Income Tax Credit. Multiply line 27a by 6% (0.06) and 
      enter result on line 27b. ........................................................... 27a.                                       00                27b.                     00
28.   Michigan Historic Preservation Tax Credit (refundable). Include Form 3581. ...........................................                             28.                      00
29.   Credit for allocated share of tax paid by an electing flow-through entity (see instructions) ........................                              29.                      00

30.   Michigan tax withheld from Schedule W, line 6. Include Schedule W (do not submit W-2s) .................                                           30.                      00

31.   Estimated tax, extension payments and 2020 credit forward .....................................................................                    31.                      00
32.   2021 AMENDED RETURNS ONLY. Taxpayers completing an original 2021 return should skip to line 33.  
      Amended returns must include Schedule AMD (see instructions).
                   If you had a refund and/or credit forward on the original return, check box 32a and enter this amount as a 
      32a.         negative number on line 32c.
                   If you paid with the original return, check box 32b and enter the amount paid with the original return, plus 
      32b.         any additional tax paid after filing, as a positive number on line 32c. Do not include interest or penalty.                           32c.                     00

33.   Total refundable credits and payments. Add lines 25, 26, 27b, 28, 29, 30, 31 and 32c ..................                          33.                                        00
REFUND OR TAX DUE
34.   If line 33 is less than line 24, subtract line 33 from line 24. If applicable, see instructions.

      Include interest          00               and penalty        00 ......................... YOU OWE                               34.                                        00

35.   Overpayment. If line 33 is greater than line 24, subtract line 24 from line 33 ................................                  35.                                        00

36.   Credit Forward. Amount of line 35 to be credited to your 2022 estimated tax for your 2022 tax return ...                                           36.                      00

37.   Subtract line 36 from line 35. ......................................................................................REFUND      37.                                        00
DIRECT DEPOSIT                                   a.  Routing Transit Number                      b.  Account Number                                            c. Type of  Account
Deposit your refund directly to your financial                                                                                                           1.    Checking 2.        Savings
institution!  See instructions and complete a, b 
and c.
Deceased Taxpayer. If Filer and/or Spouse died after December 31, 2020, enter dates below.       Preparer Certification.  I declare under penalty of perjury that 
ENTER DATE OF DEATH ONLY. Example: 04-15-2021 (MM-DD-YYYY)                                       this return is based on all information of which I have any knowledge.
                                                                                                                           Preparer’s PTIN, FEIN or SSN
Filer                                            Spouse
Taxpayer Certification.  I declare under penalty of perjury that the information in this return                            Preparer’s Name (print or type)
and attachments is true and complete to the best of my knowledge.
Filer’s Signature                                                Date                                                      Preparer’s Signature

Spouse’s Signature                                               Date                                                      Preparer’s Business Name, Address and Telephone Number

      By checking this box, I authorize Treasury to discuss my return with my preparer.

Refund, credit, or zero returns. Mail your return to:                                            Michigan Department of Treasury, Lansing, MI  48956
Pay amount on line 34 (see instructions). Mail your check and return to:                         Michigan Department of Treasury, Lansing, MI  48929

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