Michigan Department of Treasury                                                                                                                                       Attachment 28
4975 (Rev. 04-21)

2021 MICHIGAN Schedule of Corporate Income Tax Liability 
for a Michigan Business Tax Financial Filer
Issued under authority of Public Act 36 of 2007 and PA 39 of 2011.
Taxpayer Name (print or type)                                                      )HGHUDO (PSOR\HU ,GHQWL¿FDWLRQ 1XPEHU  )(,1 

3$57    &,7 7$; %()25( &5(',76 ² Unitary Business Groups, see instructions.

There is no amount to be entered on lines 1 through 4. Skip to line 5.

 1.  There is no amount 
     to be entered ........     1. X X X X X X X X X X X X X X X X                 X X X X X X X X X X X X X X X X                                                    X X X X X X X X
 2.  There is no 
     amount to be 
     entered .................  2. X X X X X X X X X X X X X X X X                 X X X X X X X X X X X X X X X X                                                    X X X X X X X X
 3.  There is no amount 
     to be entered ........     3. X X X X X X X X X X X X X X X X                 X X X X X X X X X X X X X X X X                                                    X X X X X X X X

 4.  There is no amount to be entered on this line. Skip to line 5..............................................................................                  4.  X X X X X X X X 00

 5.  Tax Base (Net Capital for Current Taxable Year) as detailed in instructions ......................................................                           5.                  00

 6.  Apportioned Tax base. Multiply line 5 by percentage on Form 4590, line 10c ...................................................                               6.                  00

 7.  Tax Liability. Multiply line 6 by 0.29% (0.0029) ...................................................................................................         7.                  00

3$57    &5(',76

 8.  &HUWL¿FDWHG 1RQUHIXQGDEOH &UHGLWV IURP )RUP       OLQH    .............................................................................                      8.                  00

 9.  Subtract line 8 from line 7. If less than zero, enter zero .....................................................................................             9.                  00

10.  Recapture from Form 4947, line 28 ....................................................................................................................       10.                 00

 11. &,7 /LDELOLW\ EHIRUH &HUWL¿FDWHG 5HIXQGDEOH FUHGLWV  $GG OLQHV   DQG    ............................................................                         11.                 00

12.  &HUWL¿FDWHG 5HIXQGDEOH FUHGLWV IURP )RUP       OLQH    ...................................................................................                   12.                 00
13.  Subtract line 12 from line 11. If less than zero, enter as a negative number. 
     (A negative number here represents an overpayment.) .....................................................................................                    13.                 00

3$57    0%7 &$/&8/$7,21 72 &203$5( $*$,167 &,7 )25 ),1$1&,$/ ),/(56

14.  Total MBT liability from Form 4590, line 30 ........................................................................................................         14.                 00

15.  Refundable credits from Form 4590, line 37 ......................................................................................................            15.                 00
16.  MBT liability after refundable credits. Subtract line 15 from line 14. If less than zero, enter as a negative 
     number. (A negative number here represents an overpayment) ........................................................................                          16.                 00
17.  ,I OLQH    LV JUHDWHU WKDQ OLQH    HQWHU WKH GLႇHUHQFH  ,I OLQH    LV JUHDWHU WKDQ RU HTXDO WR OLQH     HQWHU ]HUR  
     Carry to Form 4590, line 31 ................................................................................................................................ 17.                 00

+ 0000 2021 64 01 27 2

                                           Instructions for Form 4975
                           Schedule of Corporate Income Tax (CIT) Liability  
                           for a Michigan Business Tax (MBT) Financial Filer
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Michigan Department of Treasury
MBT Financial Worksheet A (Rev. 04-21)

2021 Michigan Business Tax Financial Institution Worksheet A

Include a copy of Worksheet A with your MBT Return. If the taxpayer is a Unitary Business Group, also complete and 
include the “Michigan Business Tax Financial Institution Worksheet B.”
Taxpayer Name or Designated Member (DM) if a UBG                                                     )HGHUDO (PSOR\HU ,GHQWL¿FDWLRQ 1XPEHU  )(,1 

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NOTE IRU OLQHV      If less than zero, enter zero.

1. Total Equity Capital. If less than zero, enter zero ..............................................................................................            1.  00

2. Average daily book value of Michigan obligations. If less than zero, enter zero ...............................................                               2.  00

3. Average daily book value of U.S. obligations .........................................................................................................        3.  00

4. Subtotal. Add lines 2 and 3 ................................................................................................................................  4.  00

5. (Net Capital) Subtract line 4 from line 1.............................................................................................................        5.  00

6. a. Authorized insurance company subsidiary: enter actual capital fund amount ................................................                                 6a. 00

   b. Minimum regulatory amount required .............................................................................................................           6b. 00

   c. Multiply line 6b by 125% (1.25) ......................................................................................................................     6c. 00

   d. Enter the lesser of line 6a or line 6c ...............................................................................................................     6d. 00

7. Subtract line 6d from line 5 ................................................................................................................................ 7.  00

Carry the amount from line 7 to the “Schedule of Corporate Income Tax (CIT) Liability for a Michigan Business Tax 
(MBT) Financial Filer” (Form 4975), line 1.

  Instructions for the Michigan Business Tax Financial Institution Worksheet A
Purpose                                                                 Lines 1 through 3: ,I OHVV WKDQ ]HUR  HQWHU ]HUR 
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Michigan Department of Treasury
MBT Financial Worksheet B (Rev. 04-21)

2021 Michigan Business Tax Financial Institution Worksheet B
Complete a copy of Worksheet B for each member of the Unitary Business Group with equity capital included in the 
Federal Financial Institutions Examination Council (FFIEC) report. Members with equity capital not included in the 
FFIEC report do not complete Worksheet B. 
Include all copies of Worksheet B with your MBT Return.
Designated Member                                         Designated Member FEIN

Unitary Business Group Member Name                        Member FEIN

NOTE IRU OLQH   DQG OLQH    If less than zero, enter zero.

1. Average daily book value of MI obligations .......................................................................................................                             1.  00

2. Average daily book value of U.S. obligations ...........................................................................................................                       2.  00

3. a. Authorized insurance company subsidiary: enter actual capital fund amount ...................................................................                               3a. 00

   b. Minimum regulatory amount required ..............................................................................................................................           3b. 00

   c. Multiply line 3b by 125% (1.25) ........................................................................................................................................... 3c. 00

   d. Enter the lesser of line 3a or line 3c .................................................................................................................................... 3d. 00

   Instructions for the Michigan Business Tax Financial Institution Worksheet B
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