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Michigan Department of Treasury (Rev. 11-21), Page 1 of 3 
                                                                                                                                                               MI-1041 
2021 MICHIGAN Fiduciary Income Tax Return
Issued under authority of Public Act 281 of 1967, as amended.  Penalty and interest apply for failure to file (see instructions). 
Type or print in blue or black ink. 
                                                                                                                                               OFFICE USE ONLY 
     Amended return                    Final return                                                              a. 
                                                                                                                 b. 

1.  For 2021, or taxable year beginning                                    - 2021  , and ending                                                                  .
                                                          MM-DD-2021                                                                           MM-DD-YYYY 
PART 1:  NAME AND IDENTIFICATION 
2. Name of Estate or Trust                                                                                              3. Federal Employer Identification Number (FEIN) 

4a. Name of Fiduciary                                          4b. Title of Fiduciary                                                              Estate Information 
                                                                                                                        5a. County 

4c. Address of Fiduciary (Number, Street, or P.O. Box)                                                                  5b. Probate File No. 

4d. City or Town                                               4e. State  4f. ZIP Code                                  5c. Date of Death (MM-DD-YYYY) 

6. Residency Status of Estate or Trust 
     a.  Resident Estate               c.  Resident Trust                  * If you check box “b”                                                  Trust Information 
                                                                           or box “d,” you must                         7.  Date Trust Was Created (MM-DD-YYYY) 
                                                                           complete and include 
     b.  Nonresident Estate *          d.  Nonresident Trust *             MI-1041 Schedule NR. 

PART 2:  INCOME AND ADJUSTMENTS (Include a copy of your U.S. Form 1041 and supporting schedules.) 
8.   Federal taxable income of fiduciary (from U.S. Form 1041 or U.S. Form 990-T   ).......................                                    8.                     00 
9.  Federal taxable income of Electing Small Business Trust (from ESBT Tax Worksheet)                               ............               9.                     00 
10.  Fiduciary’s share of Michigan net adjustments (from Schedule 3, line 42, column C, or 
     Schedule 1, line 40)....................................................................................................................  10.                    00 
11.  Capital gain or (loss) adjustment for resident estates or trusts (from MI-1041D, line 21)  ..........  11.                                                       00 
12.  Taxable income. Combine lines 8 through 11 or enter amount from MI-1041 Schedule NR, line 28.  12.                                                               00 
13.  Tax. Multiply line 12 by 4.25% (0.0425). If line 12 is a negative number, enter “0” on line 13  ...  13.                                                         00 
PART 3:  CREDITS AND PAYMENTS                                              Amount                                                                         Credit 
14.  Income tax paid to another state (include copy of return).  14a.                                                   00        14b.                                00 
15.  Michigan Historic Preservation Tax Credit .....................  15a.                                              00        15b.                                00 
16.  Total nonrefundable credits.  Add 14b and 15b        ..................................................................  16.                                     00 

17.  Income tax. Subtract line 16 from line 13. If line 16 is greater than 13, enter “0” ...............  17.                                                         00 
18.  Michigan Historic Preservation Tax Credit (refundable).  ............................................................  18.                                       00 
19.  Credit for allocated share of tax paid by an electing flow-through entity (see instructions)  ........  19.                                                      00 
20.  Income tax withheld (include MI-1041 Schedule W)  ..................................................................  20.                                        00 
21.  Michigan estimated tax and extension payments.......................................................................         21.                                 00 
22.  2020 overpayments credited to 2021 .........................................................................................  22.                                00 
23.  2021 AMENDED RETURNS ONLY. Taxpayers completing an original 2021 return should 
     skip to line 24. Enter refund and/or credit forward on the original return as a negative number. 
     Enter amount paid with original return as a positive number (see instructions)  ........................  23.                                                    00 

24.  Total Refundable Credits and Payments. Add lines 18 through 23................................                     24.                                           00 
PART 4:  TAX DUE OR REFUND 
25.  If line 24 is less than line 17 enter TAX DUE. 
     Include interest                  and penalty                         if applicable............                PAY 25.                                           00

26.  If line 24 is greater than line 17, enter overpayment  ..........................................................  26.                                           00 

27.  Amount of line 26 to be credited to your 2022 fiduciary return  ...................................................  27.                                         00 

28.  Subtract line 27 from line 26.............................................................................. REFUND 28.                                           00 
                                                           Continue on page 2. This form cannot be processed if page 2 is not completed and included. 

2021 MI-1041, Page 2 of 3                                                                                               Federal Employer Identification Number (FEIN) 

SCHEDULE 1:  NET MICHIGAN ADJUSTMENT FOR RESIDENT ESTATES OR TRUSTS 

Additions 
29.  Gross interest and dividends from obligations issued by states other than Michigan 
     or their political subdivisions...........................................................................................................  29.                   00 
30.  Deduction for taxes imposed on or measured by income taken on U.S. Form 1041 and allocated 
     share of tax paid by an electing flow-through entity (see instructions)  ............................................                       30.                   00 

31.  Expenses included on U.S. Form 1041 attributable to income from sources outside of Michigan..                                               31.                   00 
32.  Expenses and interest incurred in production of income from U.S. government 
     obligations on U.S. Form 1041  ........................................................................................................  32.                      00 

33.  Other (Include supporting documentation) Describe:                                                                                          33.                   00 

34.  Total additions. Add lines 29 through 33  ...........................................................................  34.                                        00 

Subtractions 
35.  Income from U.S. government bonds and other obligations to the extent included in 
     federal taxable income  ................................................................................................................... 35.                   00 
36.  Income attributable to another state. 
     Explain type and source:_________________________________________________________  36.                                                                            00 

37.  Expenses related to obligations of other states not deducted on U.S. Form 1041  ........................................                    37.                   00 

38.  Other (Include supporting documentation) Describe:_________________________________                                                         38.                   00 

39.  Total Subtractions. Add lines 35 through 38  .....................................................................  39.                                           00 
40.  Net Michigan Adjustment. Subtract line 39 from line 34. If no distribution to 
     beneficiaries, carry this amount to line 10. Otherwise, complete Schedules 2 and 3  .........  40.                                                                00 

EXPLANATION OF CHANGES. If filing an amended return, complete this section. 
41.  Explain changes to income, deductions and credits. Show computations in detail and include a copy of the amended 
U.S.  Form 1041 and all supporting schedules. 

SIGNATURES AND DECLARATIONS 
I declare under penalty of perjury that the information in this return and attachments is true and I declare under penalty of perjury that this return is based on all 
complete to the best of my knowledge.                                                              information of which I have any knowledge. 
Signature of Fiduciary or Officer Representing Fiduciary Date                                      Preparer’s PTIN, FEIN or SSN 

                                                                                                   Preparer’s Name (print or type) 
     By checking this box, I authorize Treasury to discuss my return with my preparer. 
This return is due April 18, 2022, or on the 15th day of the fourth month                          Preparer’s Signature 
after the close of the tax year. 
                                                                                                   Preparer’s Business Name, Address and Telephone Number 
WITHOUT  PAYMENT: Mail return to:       WITH PAYMENT: Pay amount on 
Michigan Department of Treasury         line 25. Mail check and return to: 
P.O. Box 30058                          Michigan Department of Treasury 
Lansing, MI 48909                       Department 781041 
                                        P.O. Box 78000 
                                        Detroit, MI 48278 
Make check payable to “State of Michigan” and write the estate’s or trust’s FEIN and “2021 MI-1041” on the front of the check. 
                                                         Continue on page 3. This form cannot be processed if page 3 is not completed and included. 

2021 MI-1041, Page 3 of 3                                                                                               Federal Employer Identification Number (FEIN) 

Instructions: Complete Schedules 2, 3 and 4 as applicable. If additional space is needed, complete the Michigan Fiduciary Income Tax 
Information Continuation Schedule (Form 5680). 
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 

Example:        Joseph Smith               R          123 Main Street, Anywhere, MI 12345                                              111-11-1111 

a. 

b. 

c. 

d. 

SCHEDULE 3: ALLOCATION OF NET MICHIGAN ADJUSTMENT FOR RESIDENT ESTATES OR TRUSTS 
Complete Schedule 3 only if adjustments were entered on Schedule 1. 
                                                    A                                                                   B              C 
                                     Federal Distributable Net Income                                                   Percentage     Allocation of Net 
   Beneficiary                                                                                                          of Amount  Michigan Adjustment 
Identification                                                                                                          in         (Multiply amount on line 
    from                    Type of Income            Location                                                          Column A   40 by percentage in
   Schedule 2      (Dividend, Interest, Rent, etc.) (City, State)                                                Amount                 Column B.) 

    a.                                                                                                                        % 

    b.                                                                                                                        % 

    c.                                                                                                                        % 

    d.                                                                                                                        % 

                                                                                                                              % 
42. Fiduciary’s Share .......................................................................................... 
                                                                                                                        100   % 
43. Total. Include amounts from Form 5680 (if applicable)................................. 
SCHEDULE 4: CAPITAL GAIN OR (LOSS) DISTRIBUTED TO BENEFICIARIES WHEN FORM MI-1041D IS FILED 
Schedule 4 must be completed for resident or nonresident estates and trusts if capital gains/losses were distributed to beneficiaries and a Michigan 
Adjustments of Capital Gains and Losses (Form MI-1041D) was filed. 
   Beneficiary                               A                                                                              B 
Identification 
    from                                   Federal                                                                      Michigan 
   Schedule 2                        Gain or (Loss)                                                                     Gain or (Loss) 
    a. 

    b. 

    c. 

    d. 

44. Total. Include 
amounts from 
Form 5680  
(if applicable)