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Michigan Department of Treasury Attachment 07
4577 (Rev. 04-21), Page 1 of 2
0,&+,*$1 %XVLQHVV 7D[ 6FKHGXOH RI 6KDUHKROGHUV DQG 2ႈFHUV
For all Corporations claiming the Small Business Alternative or Start-Up Business Credits
Issued under authority of Public Act 36 of 2007.
Taxpayer Name (If Unitary Business Group, Name of Designated Member) )HGHUDO (PSOR\HU ,GHQWL¿FDWLRQ 1XPEHU )(,1 RU 75 1XPEHU
Unitary Business Groups Only: Name of Unitary Business Group Member Reporting on This Form )HGHUDO (PSOR\HU ,GHQWL¿FDWLRQ 1XPEHU )(,1 RU 75 1XPEHU
PART 1: SHAREHOLDERS AND OFFICERS. See instructions.
1. AB CDEFG
FEIN or Check % Stock with % Stock from Col. F less
Member Name of shareholder (including corporation, trust, partnership, or family member Social Security number (X) if an % Stock attribution any attribution between
Number ZKR LV D VKDUHKROGHU WKURXJK DWWULEXWLRQ RU RႈFHU /DVW )LUVW 0LGGOH RI VKDUHKROGHU RU RႈFHU RႈFHU directly owned (See instructions.) two active shareholders
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Percent of stock (not listed above) owned by shareholders who own less than 10% and receive no compensation: %
Total: 100 %
Continue below using the same Member Number references from column 1A.
HI J K L M N
Dividends Total compensation and director
Member (used to determine Salaries, wages and/ Employee insurance IHHV IRU RႈFHUV DQG RU VKDUH Share of business income/loss 7RWDO VKDUHKROGHU RႈFHU
Number active shareholders) or director fees plans, pensions, etc. holders. Add columns J and K. (See instructions.) income. Add columns L and M.
If more space is needed, include additional 4577 forms. Identify taxpayer and complete Part 1 and Part 2 on each additional form. (See instructions.)
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