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Michigan Department of Treasury 
4884 (Rev. 09-20), Page 1 of 2                                                         Include with Form MI-1040 and Schedule 1. 

2020 MICHIGAN Pension Schedule (Form 4884) 
Generally, if the filer and spouse were born after 1945, STOP; you are not entitled to a retirement and pension benefits subtraction. For exceptions, refer to 
the instructions and the questionnaire “Which Section of Form 4884 Should I Complete?” for additional assistance. 
Failure to complete this form in its entirety will result in your pension subtraction being denied. 
Issued under authority of Public Act 281 of 1967, as amended. Type or print in blue or black ink.                                     Attachment 23 
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) 

PART 1: FILING INFORMATION 
4. Primary Filer Year of Birth (ex. 19xx)                               5.  If a Joint Return, Spouse Year of Birth (ex. 19xx) 

6.        Check here if you were born after 1953, were retired as of January 1, 2013, and received retirement benefits from SSA exempt employment. 

7. If you are receiving retirement and pension benefits from a deceased spouse who was born prior to January 1, 1953, complete lines 7a through       7d.
7a. Deceased Spouse Name                                       7b. Deceased Spouse Full Social Security No. 7c. Deceased Spouse Year of Birth (ex. 19xx) 

          Surviving spouse. Check here if you elect to subtract retirement and pension benefits based on the year of birth of your deceased 
7d.       spouse. You must be the surviving spouse who (1) has reached age 67, (2) has not remarried, and (3) claimed a subtraction for retirement 
          and pension benefits on a return jointly filed with the decedent in the year they died. See instructions. 
PART 2: RETIREMENT AND PENSION BENEFITS (see instructions) 
Do not enter Social Security, military or railroad retirement benefits here (see Schedule 1).
8. Retirement and pension benefits. List all that apply for filer (and spouse if filing jointly) including benefits from a deceased spouse. 
      A               B                   C                    D                            E                                         F 
Enter “X” for     Enter  “X” for Payer FEIN (from 1099-R)    Distribution                                                             Pension Amount 
Private or Public Deceased       (Example: 38-1234567)                                 Name of Payer                                                  
                   Spouse                 (see instructions)   Code                                                                   Included in AGI

                                                                                                                                                      00 

                                                                                                                                                      00 

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                                                                                                                                                      00 

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                                                                                                                                                      00 

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                                                                                                                                                      00 
      Check here and complete the Michigan Pension Continuation Schedule (Form 4973) if you have more than ten sources of 
      Retirement and Pension Benefits. 

                                               Continue on page 2. This form cannot be processed if page 2 is not completed and included. 
                                                               You must also include a completed MI-1040 and Schedule 1 when filing Form 4884. 
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2020 Form 4884, Page 2 of 2                                                             Filer’s Full Social Security Number (Example: 123-45-6789) 

PART 3: To determine which section below to complete, review the questionnaire: “Which Section of Form 4884 
Should I Complete?” in the MI-1040 book. Complete only one of the sections below. 

SECTION A: 
  9. Enter $53,759 if single or $107,517 if filing jointly.  Reduce this amount by any military or railroad 
     retirement benefits from Schedule 1, line 11  ...................................................................................                    9.  00 
10.  Enter total public retirement and pension benefits (including public benefits received from a 
     deceased spouse if deceased spouse was born prior to January 1, 1946 and died prior to 2020)  .                                                      10. 00 

11.  Subtotal. Subtract line 10 from line 9. If line 10 is more than line 9, enter “0”  ..................................                                11. 00 
12.  Enter total private retirement and pension benefits (including private benefits received from a 
     deceased spouse if deceased spouse was born prior to January 1, 1946 and died prior to 2020)  .                                                      12. 00 
13.  If deceased spouse was born between January 1, 1946 and December 31, 1952 and died prior 
     to 2020, enter deceased spouse retirement and pension benefits (maximum $20,000 if single or 
     $40,000 if filing jointly).  .....................................................................................................................   13. 00 

14.  Add lines 12 and 13.  .........................................................................................................................      14. 00 

15.  Enter the smaller of lines 11 or 14  ....................................................................................................            15. 00 
16.  Total Retirement and Pension Benefits Subtraction.  Add lines 10 and 15. Carry this amount to 
     Schedule 1, line 25  ...........................................................................................................................     16. 00 
SECTION B: 
17.  Enter $53,759 if single or $107,517 if filing jointly.  Reduce this amount by any military or railroad 
     retirement benefits from Schedule 1, line 11 ...................................................................................                     17. 00 
18.  Enter public benefits received from a deceased spouse born prior to January 1, 1946 and died 
     prior to 2020  ..................................................................................................................................... 18. 00 

19.  Subtotal. Subtract line 18 from line 17. If line 18 is more than line 17, enter “0”  .............................                                   19. 00 
20.  Enter private benefits received from a deceased spouse born prior to January 1, 1946 and died 
     prior to 2020  ..................................................................................................................................... 20. 00 

21.  Enter the smaller of lines 19 or 20  ....................................................................................................            21. 00 

22.  Add lines 18 and 21  ..........................................................................................................................      22. 00 

23.  Enter total filer and spouse retirement and pension benefits  ...........................................................                            23. 00 

24.  Maximum Allowable Pension Deduction. See instructions  ...............................................................                               24. 00 

25.  Subtract line 22 from line 24. If line 22 is more than line 24, enter “0”  .............................................                             25. 00 

26.  Enter the smaller of lines 23 or 25  ....................................................................................................            26. 00 
27.  Total Retirement and Pension Benefits Subtraction.  Add lines 22 and 26. Carry this amount to 
     Schedule 1, line 25  ...........................................................................................................................     27. 00 
SECTION C: 
28.  Total Retirement and Pension Benefits Subtraction. Enter total retirement and pension
     benefits, including benefits received from a deceased spouse who died prior to 2020 (maximum
     $20,000 if single or $40,000 if filing jointly). If you checked box 22C and/or 22G on Schedule 1
     or have military or railroad retirement benefits reported on Schedule 1, line 11, see instructions. 
     Carry this amount to Schedule 1, line 25..........................................................................................                   28. 00 

SECTION D: 
29.  Total Retirement and Pension Benefits Subtraction.  If you checked box 22C and/or 22G on 
     Schedule 1 and the older of you or your spouse was born after January 1, 1954 but before 
     January 2, 1959, enter retirement and pension benefits you received, up to $15,000 per eligible 
     taxpayer. If you have military or railroad retirement benefits reported on Schedule 1, line 11, see 
     instructions. Carry this amount to Schedule 1, line 25  ......................................................................                       29. 00 

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