Michigan Department of Treasury
Reset Form
501 (Rev. 05/08)
Tax Clearance Request For Corporation Dissolution or Withdrawal
Issued under the authority of Public Act 228 of 1975, as amended.
NOTICE TO CORPORATIONS: A tax clearance certificate must be obtained within 60 days of dissolution or withdrawal of
a corporation from the State of Michigan. A certificate will not be issued until all returns are filed and all liabilities are paid.
For additional information, see Tax Clearance Information (Form 515). This form must be completed in its entirety.
Federal Employer Identification Number (FEIN)
Corporate Identification (CID) Number
Corporation Name* (list any corporate name change below)
Street Address
City
State
ZIP Code
Date Business Actually Discontinued in Michigan
Ending Date of Last Payroll Subject to Michigan Withholding
(mm/dd/yyyy)
(mm/dd/yyyy)
Date Incorporated
State Incorporated In (If foreign corporation, also complete Form 508)
(mm/dd/yyyy)
Name Incorporated Under
Date Foreign Corporation Authorized to Transact Business in Michigan
(mm/dd/yyyy)
Type of Action Requested of the Michigan Department of Labor and Economic Growth, Corporation Division
Effective Date
(mm/dd/yyyy)
Dissolution
Withdrawal (From the State of Michigan)
How does your corporation file the Michigan Annual Report?
Profit
Non-Profit
Is corporation undergoing 12-month liquidation?
If yes, date liquidation will be complete
(mm/dd/yyyy)
Yes
No
*Name Changes and Dates:
If this corporation had no tax liability or was not required to register with the Michigan Department of Treasury, provide a detailed explanation. Substantiate with attachments.
Is there a corporation assuming assets or continuing activity of this corporation?
If yes, enter its name
Enter its FEIN
Yes
No
Street Address
City
State
ZIP Code
Certification: I declare under penalty of perjury that I am the owner or authorized representative of the business on which tax clearance is requested
and that the information entered is true. (Submit a Limited Power of Attorney (Form 3840) if not the owner, officer or member.)
Print Name
Title
Telephone Number
Signature
Date
Attach a copy of your final tax returns with proof of payment, if any, and mail to:
Tax Clearance Section
Michigan Department of Treasury
P.O. Box 30199
Lansing, MI 48909