Form 4262 - Annual Revenue Report For Michigan Tax Information (Local Government Units)

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Michigan Department of Treasury
4262 (03-12)
Annual Revenue Report for Michigan Tax Information
(Local Government Units)
Issued under authority of P.A. 122 of 1941, as amended.
This report must be completed by the local government unit based on tax extract and return
information provided by the Michigan Department of Treasury. Send the report to the address listed
on the bottom of this form.
Current Calendar Year
Michigan Tax Extract Report Year(s)
Number and cost of Michigan Tax Extract Records Requested..
____________
Cost
$____________
(number)
Number and cost of Michigan Tax Returns Requested.............
____________
Cost
$____________
(number)
Total Cost of Michigan Tax Information
$____________
$____________
Revenue Billed from Michigan Tax Information for the Extract Year(s)..................
$____________
Revenue Collected from this Amount (optional).....................................................
Was the Michigan tax information beneficial in your compliance efforts?
Yes
No
Comments:
I certify that all information contained in this report is true and accurate.
Signature of Authorized Local Government Official
Date
Print Name of Authorized Local Government Official
Name of Local Government Unit
Office of Privacy and Security
Disclosure Unit
430 W. Allegan St.
Lansing MI 48922
(517) 636-5340 FAX

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