Michigan Department of Treasury 511 (Rev. 09-12)
Tax Status Letter Request
Issued under authority of Public Act 122 of 1941
IMPORTANT: A tax status letter does not constitute a certiicate of good standing issued by the Department of Licensing and Regulatory
Affairs and relating to annual corporate reports and privilege fees.
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Date |
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Current Business or Corporate Name |
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Federal Employer Identiication Number (FEIN) |
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Corporate Identiication (CID) Number |
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Street Address |
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City |
State |
ZIP Code |
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Date Incorporated / Qualiied (mm/dd/yyyy) |
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State Incorporated In |
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List Any Corporate Name Change(s) |
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Date of Change |
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Requested By (print name) |
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1. |
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Street Address (if different from above) |
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2. |
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3. |
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City |
State |
ZIP Code |
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(use space below if necessary) |
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Certiication: I declare under penalty of perjury that I am the owner, oficer, or member of the business on which tax clearance is requested and that the information is true. (Submit a Limited Power of Attorney (Form 3840) if not the owner, oficer, or member)
Printed Name of Requestor |
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Telephone Number |
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Signature of Requestor |
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Date |
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Complete the requested information in its entirety and send to:
Tax Clearance Section
Michigan Department of Treasury
P.O. Box 30168
Lansing, MI 48909
Contact us for assistance: (517) 636-5260