Michigan Voluntary Contributions Schedule

Voluntary Contributions Schedule
4642, 2024  Michigan Voluntary Contributions Schedule and Organ Donor Registry
Reset Form
Michigan Department of Treasury
4642 (Rev. 05-24)

Issued under authority of Public Act 281 of 1967, as amended.

2024 MICHIGAN Voluntary Contributions and Organ Donor Registry Schedule
Type or print in blue or black ink.

Attachment 18

Filer’s First Name

M.I.

Last Name

Filer’s Full Social Security No. (Example: 123-45-6789)

If a Joint Return, Spouse’s First Name

M.I.

Last Name

Spouse’s Full Social Security No. (Example: 123-45-6789)

Voluntary Contributions
Use this schedule to make a donation from your refund to any of the organizations listed below. If you are not receiving a refund,
your donation will increase your tax due. Check the box associated with the dollar amount you wish to contribute in columns A
or B or enter a specific dollar amount greater than $10 in the space provided in column C. Enter the total of your contribution for
each line in column D. For detailed descriptions of each fund, see instructions. This form must be included with your MI-1040
to ensure your contributions are properly credited to the designated fund(s).
A.

B.

C. Other Amount

D. Total Contribution

(greater than $10)

1.

American Red Cross Michigan Fund..........

$5

$10

$

00

.................

1.

00

2.

Animal Welfare Fund ...................................

$5

$10

$

00

.................

2.

00

3.

Children Trust Michigan - Prevent Child
Abuse Michigan ...........................................

$5

$10

$

00

.................

3.

00

4.

Military Family Relief Fund ..........................

$5

$10

$

00

.................

4.

00

5.

United Way Fund.........................................

$5

$10

$

00

.................

5.

00

6.

Add column D, lines 1 through 5. Enter total of column D here and carry amount to your MI-1040, line 21........

6.

00

Organ Donor Registry

Check the box to join the Michigan Organ Donor Registry. An individual taxpayer willing to participate in the anatomical gift donor registry
must complete this schedule and submit it with the taxpayer’s state income tax return (MI-1040). The state’s confidential database
allows residents to sign up to be an organ, tissue and/or eye donor after death. The Donor Registry database is accessible by Gift of Life
Michigan, the state’s federally designated organ procurement organization, to assist in the recovery and transplantation of organs and
tissues. As a donor, your gift will be used to help others through transplantation, therapy, research and/or education. After registering,
you will receive a donor heart sticker for your Michigan driver’s license or state ID. If you already have the heart symbol, you are already
registered and completing this schedule is unnecessary. For more information on the Donor Registry, see instructions.
Filer’s Date of Birth (mm-dd-yyyy)

a.

Check here if Filer is willing to participate in the Michigan Organ Donor Registry ..................................
Spouse’s Date of Birth (mm-dd-yyyy)

b.

+ 0000

Check here if Spouse is willing to participate in the Michigan Organ Donor Registry .............................

2024 82 01 27 8

2024 Form 4642, Page 2

Instructions for Form 4642, Voluntary Contributions and Organ
Donor Registry Schedule
Voluntary Contributions
Michigan taxpayers can contribute $5, $10, or more to any
of the following funds on the Voluntary Contributions and
Organ Donor Registry Schedule (Form 4642). Contributions
to these funds will increase your tax liability or reduce
your refund.

American Red Cross Michigan Fund
The American Red Cross is always there for you and your
community, helping to alleviate suffering caused by disasters
big and small. The Red Cross shelters, and provides emotional
support to Michigan residents and beyond; supplies about 40
percent of the nation’s blood; teaches skills that save lives;
provides international humanitarian aid; and supports military
members and their families. By mobilizing the power of
volunteers and the generosity of donors, the Red Cross responds
to more than 60,000 disasters annually. In Michigan, last year
more than 6,000 volunteers logged more than 200,000 hours
assisting others. On average 91 cents of every dollar the Red
Cross spends is invested in humanitarian services.
Animal Welfare Fund
The outside world can be a harsh, scary place for homeless pets.
And throughout Michigan, small towns and big cities alike
struggle to find the resources they need to provide medical care
to the animals they rescue. Through the Animal Welfare Fund,
the Michigan Department of Agriculture and Rural Development
provides grants to Michigan’s registered animal shelters for
spay/neuter and care programs for shelter dogs and cats up for
adoption. Grants also help support many local anti-cruelty and
animal care programs around the state. Shelters also use grant
monies from your generous donations to help care for animals
seized as part of animal cruelty and hoarding cases.
Children Trust Michigan - Prevent Child Abuse
Michigan
Every checked box represents a crucial step in the Children
Trust Michigan’s (CTM) goal to support strong families where
children are happy, supported, and have access to a bright future.
Your contributions have helped reach all 83 counties with over
100 impactful programs delivered by prevention partners to
meet specific, local needs. CTM provides the needed funding
so our partners can reach more than 176,000 children in nearly
22,000 community-based educational sessions. Together parents,
caregivers, and children have the resources needed to prevent
abuse and neglect.
Military Family Relief Fund
The Military Family Relief Fund provides grants to
qualifying families of military members in either the
Michigan National Guard or Reserves who are called
to active duty as a result of the national response to the
September 11, 2001 terrorist attacks or a national emergency.
A portion of these funds also goes toward the Michigan

Veteran Homes Charitable Support Fund that supports a
variety of programs including veteran social activities and
events, entertainment, special equipment to benefit veterans,
annual volunteer recognition, enhanced quality of life
programming, and so much more.

United Way Fund
United Way fights for the health, education, and financial
stability of every person in every community. By
contributing to the United Way Fund, you’re insuring that
your dollars stay local and work to improve the lives of
individuals and families in your community by providing
for basic needs, including, but not limited to, food, clothing,
and shelter. United Way’s greatest strength is understanding
the needs of local communities – but we’re more than just a
fundraiser. We mobilize thousands of volunteers, donors, and
advocates across your community and the State of Michigan
to help change lives through service, collaboration, and
impact. Come join us and help Michigan Live United.

Organ Donor Registry Schedule
Registering as an organ donor is an important step for
anyone who decides to help others through the gift of organ,
eye, and tissue donation. Anyone is a potential organ donor
regardless of age or medical conditions. An organ donor can
save up to eight lives and a tissue donor can heal up to 125
people. As an organ donor, your gift will be used to help
others through transplantation, therapy, research and/or
education. After registering, you will receive a donor heart
sticker for your Michigan driver’s license or state ID.
The Michigan Organ Donor Registry is a confidential
database of residents who wish to be organ, eye, and
tissue donors after death. Individuals who are already on
the registry do not need to complete the donor registry
schedule. To remove your name, contact the Michigan
Department of State at www.michigan.gov/sos.
For more information, contact the Gift of Life Michigan at
1-866-500-5801 or www.giftoflifemichigan.org or 3861
Research Park Drive, Ann Arbor, MI 48108.
Note: Treasury does not maintain a record of any
individual’s registry status.