Michigan Insurance Company Annual Return for Corporate Income and Retaliatory Taxes

Insurance Company Annual Return for Corporate Income and Retaliatory Taxes
4905, 2024 Insurance Company Annual Return for Corporate Income and Retaliatory Taxes
Michigan Department of Treasury
4905 (Rev. 09-24), Page 1 of 2

This form cannot be used as
an amended return; use the
Insurance Company Amended
Return for Corporate Income and
Retaliatory Taxes (Form 4906).

2024 Insurance Company Annual Return for
Corporate Income and Retaliatory Taxes
Issued under authority of Public Act 38 of 2011.
1. Taxpayer Name

2. Federal Employer Identification Number (FEIN)

Address (Number, Street)
3.
City

State

ZIP/Postal Code

Check if Foreign Insurer

Country Code 4. State of Incorporation (use 2 letter abbreviation)

A

DIRECT PREMIUMS WRITTEN IN MICHIGAN

B

See instructions before completing lines 5 through 23.
Qualified Health Ins. Policies
5. Gross direct premiums written in Michigan................................................................ 5.
00
6. Premiums on policies not taken................................................................................. 6.
00
7. Returned premiums on canceled policies.................................................................. 7.
00
8. Receipts on sales of annuities................................................................................... 8.
00
9. Receipts on reinsurance assumed (see instructions)................................................ 9.
00
10. Add lines 6 through 9................................................................................................. 10.
00
11. Direct Premiums Written in Michigan. Subtract line 10 from line 5.
If less than zero, enter zero ....................................................................................... 11.

All Other Policies

00
00
00
00
00
00

00

00

12.

00

00

Proportional share of limit and phase-out.
Column A: Divide line 12, column A, by the sum of line 12, columns A and B.
Column B: Divide line 12, column B, by the sum of line 12, columns A and B......... 13.

%

%

DISABILITY INSURANCE EXEMPTION
12. Disability insurance premiums written in Michigan, not including credit or disability
income insurance premiums (see instructions)...........................................................
13.

14.
15.
16.
17.
18.
19.
20.

Enter the sum of all disability insurance premiums from both columns of line 12
OR $190,000,000, whichever is less ...............................................................................................
Gross direct premiums from insurance carrier services everywhere...............................................
Phase out ........................................................................................................................................
Subtract line 16 from line 15. If less than zero, enter zero ..............................................................
Exemption reduction. Multiply line 17 by 2 ......................................................................................
Subtract line 18 from line 14. If less than zero, enter zero ..............................................................
Allocated reduced exemption.
Column A: Multiply line 19 by the percentage on line 13, column A.
Column B: Multiply line 19 by the percentage on line 13, column B .......................

14.
15.
16.
17.
18.
19.

00
00
280,000,000 00
00
00
00

20.

Adjusted tax base.
Column A: Subtract line 20, column A, from line 11, column A.
Column B: Subtract line 20, column B, from line 11, column B............................... 21.
22. Multiply line 21, column A, by 0.9477% and column B by 1.25% (0.0125)................ 22.
23. Tax before credits. Add line 22, columns A and B............................................................................

00

00

00
00

00
00

21.

23.

00

CREDITS

24. Enter amounts paid from 1/1/2023 to 12/31/2023 to each of the following:
a. Michigan Workers’ Compensation Placement Facility.....................................................................................
b. Michigan Basic Property Insurance Association..............................................................................................
c. Michigan Automobile Insurance Placement Facility ........................................................................................
d. Property and Casualty Guaranty Association ..................................................................................................
e. Michigan Life and Health Insurance Guaranty Association .............................................................................
25. Add lines 24a through 24e......................................................................................................................................
26. Michigan Examination Fees or Regulatory Fee......................................................................................................
27. Credit. Multiply line 26 by 50% (0.50).....................................................................................................................
28. Subtract line 25 and line 27 from line 23 ................................................................................................................
29. Tax Liability after Historic Preservation Credit from Form 5793, line 11. If less than or equal to $100, enter zero
30. Total Recapture of Certain Business Tax Credits from Form 4902.........................................................................
31. Total Michigan Tax. Add line 29 and line 30 .........................................................................................................

+

0000 2024 38 01 27 1

24a.
24b.
24c.
24d.
24e.
25.
26.
27.
28.
29.
30.
31.

00
00
00
00
00
00
00
00
00
00
00
00
Continue and sign on Page 2

2024 Form 4905, Page 2 of 2

Taxpayer FEIN

Foreign and alien insurers complete lines 32 through 46. Use column A to report burdens that would be imposed by the taxpayer’s state of
incorporation on a hypothetical Michigan company doing the same business in that state. Use column B to report actual burdens imposed by
Michigan on the taxpayer.
A
B
State of Incorporation
Michigan
TAXES
32.
33.

State of incorporation tax.......................................................................
Michigan Tax from line 31......................................................................

32.
33.

34.
35.
36.
37.
38.

Annual statement filing fee ....................................................................
Certificate of Authority renewal fee........................................................
Certificate of Compliance ......................................................................
Certificate of Deposit .............................................................................
Certificate of Valuation...........................................................................

34.
35.
36.
37.
38.

39. Other fees. Include a detailed schedule of fees ....................................
40. Fire Marshall Tax ...................................................................................
41. Second Injury Fund ...............................................................................
42. Silicosis and Dust Disease Fund ...........................................................
43. Safety Education and Training Fund .....................................................

39.
40.
41.
42.
43.

44.

44.

FEES AND ASSESSMENTS

Other assessments. Include a detailed schedule of assessments ........

TOTAL

X X X X X X X X

45. Total Taxes, Fees and Assessments. Add lines 32 through 44............. 45.
46. Retaliatory Amount. Subtract line 45, column B, from column A. If less than zero, enter zero..............................
47. Total Tax Liability. Add lines 31 and 46. Domestic insurers, enter amount from line 31.......................................

PAYMENTS AND TAX DUE

48. Overpayment credited from prior period return ......................................................................................................
49. Estimated tax payments .........................................................................................................................................
50. Tax paid with request for extension ........................................................................................................................
51. Michigan tax withheld or Flow-Through Entity credit (see instructions)..................................................................
52. Workers’ Disability Supplemental Benefit (WDSB) Credit (attach document) ........................................................
53. Total Payments. Add lines 48 through 52 ...............................................................................................................
54. TAX DUE. Subtract line 53 from line 47. If less than zero, leave blank..................................................................
55. Underpaid estimate penalty and interest from Form 4899, line 38.........................................................................
56. Annual Return Penalty (see instructions) ...............................................................................................................
57. Annual Return Interest (see instructions) ...............................................................................................................
58. PAYMENT DUE. If line 54 is blank, go to line 59. Otherwise add lines 54 through 57...........................................

OVERPAYMENT, REFUND OR CREDIT FORWARD

59. Overpayment. Subtract line 47, 55, 56 and 57 from line 53. If less than zero, leave blank (see instructions)...........
60. CREDIT FORWARD. Amount on line 59 to be credited forward and used as an estimate for next tax year.............
61. REFUND. Subtract line 60 from line 59..................................................................................................................

Taxpayer Certification. I declare under penalty of perjury that the information in
this return and attachments is true and complete to the best of my knowledge.

X X X X X X X X
X
X
X
X
X

X
X
X
X
X

X
X
X
X
X

X
X
X
X
X

X
X
X
X
X

X
X
X
X
X

46.
47.

00
00

48.
49.
50.
51.
52.
53.
54.
55.
56.
57.
58.

00
00
00
00
00
00
00
00
00
00
00

59.
60.
61.

00
00
00

Preparer Certification.

I declare under penalty of perjury that this
return is based on all information of which I have any knowledge.

By checking this box, I authorize Treasury to discuss my return with my preparer.

Authorized Signer’s Name (print or type)
Title

+

0000 2024 38 02 27 9

Preparer’s Business Name (print or type)

Date
Telephone Number

X
X
X
X
X

X X X X X X X X

Preparer’s PTIN, FEIN or SSN
Authorized Signature for Tax Matters

X
X
X
X
X

Preparer’s Business Address and Telephone Number (print or type)

Instructions for Form 4905
Insurance Company Annual Return for Corporate Income and Retaliatory Taxes
Purpose
To	 calculate	 premiums	 tax	 levied	 on	 insurance	 companies	
under	 the	 Corporate	 Income	 Tax	 and	 to	 claim	 credits	 against	
that	 tax.		 Foreign	 insurers	 must	 also	 compare	 burdens	 in	 order	
to	 determine	 if	 retaliatory	 tax	 is	 due,	 and	 calculate	 that	 tax,	 if	
due.

Effects of Public Act 222 of 2018
PA	 222	 of	 2018	 amended	 MCL	 206.635,	 which	 levies	 a	 tax	 on	
insurance	 companies	 equal	 to	 1.25%	 of	 gross	 direct	 premiums	
written	 on	 risk	 located	 or	 residing	 in	 Michigan.	 For	 the	 2024	
tax	 year,	 gross	 direct	 premiums	 attributable	 to	 qualified	 health	
insurance	premiums	are	taxed	at	0.9477%.	(See	the	instructions	
under	 “Direct	 Premiums	 Written	 in	 Michigan”	 for	 a	 definition	
of	 qualified	 health	 insurance	 policies.)	 The	 remaining	 portion	
of	the	tax	base	is	still	taxed	at	1.25%.

Line-by-Line Instructions
Lines	not	listed	are	explained	on	the	form.
Do	not	enter	data	in	boxes	filled	with	Xs.
Amended Returns:	 To	 amend	 a	 current	 or	 prior	 year	 annual	
return,	 complete	 the Insurance Company Amended Return for
Corporate Income and Retaliatory Taxes	 (Form	 4906)	 that	 is	
applicable	 for	 that	 year,	 and	 attach	 a	 separate	 sheet	 explaining	
the	 reason	 for	 the	 changes.	 Complete	 and	 file	 all	 schedules,	 all	
forms	 and	 all	 attachments	 filed	 with	 the	 original	 return,	 even	
if	 not	 amending	 information	 on	 a	 particular	 form	 or	 schedule.	
Include	 a	 copy	 of	 an	 amended	 federal	 return	 or	 a	 signed	 and	
dated	 IRS	 audit	 document,	 if	 applicable.	 Do not include a copy
of the original return with the amended return.	 Find	 detailed	
instructions	on	Form	4906.
Line 1:	 Enter	 the	 complete	 name	 and	 address	 including	 the	
two-digit	 abbreviation	 for	 the	 country	 code.	 See	 the	 list	 of	
country	 codes	 in	 the	 Corporate Income Tax (CIT) Forms and
Instructions for Insurance Companies	(Form	4904).
NOTE: Any	 correspondence	 regarding	 the	 return	 filed	 and/
or	 refund	 will	 be	 sent	 to	 the	 address	 provided	 on	 this	 form.	
The	 taxpayer’s	 primary	 address	 in	 Treasury	 files,	 identified	 as	
the	 legal	 address	 and	 used	 for	 all	 purposes	 other	 than	 refund	
and	 correspondence	 on	 a	 specific	 CIT	 return,	 will	 not	 change	
unless	 the	 taxpayer	 files	 a	 Notice of Change or Discontinuance
(Form	163)	with	Treasury.
FOREIGN FILERS:	Complete	the	address	fields	as	follows:

Line 2:	 Enter	 the	 taxpayer’s	 Federal	 Employer	 Identification	
Number	 (FEIN).	 Be	 sure	 to	 use	 the	 same	 account	 number	 on	
all	 forms.	 The	 taxpayer	 FEIN	 from	 line	 2	 must	 be	 entered	 in	
the	Taxpayer	FEIN	field	on	page	2.
NOTE:	 Unless	 already	 registered,	 taxpayers	 must	 register	
with	 the	 Michigan	 Department	 of	 Treasury	 before	 filing	 a	
tax	 return.	 Taxpayers	 are	 encouraged	 to	 register	 online	 at	
www.michigan.gov/businesstaxes.	 Taxpayers	 that	 register	
with	 Treasury	 online	 receive	 their	 registration	 confirmation	
within	seven	days.
If	 the	 taxpayer	 does	 not	 have	 an	 FEIN,	 the	 taxpayer	 	 must	
obtain	 an	 FEIN	 before	 filing	 the	 CIT.	 Visit	 www.michigan.
gov/businesstaxes	for	more	information	on	obtaining	an	FEIN.
Returns received without a registered account number will
not be processed until such time as a number is provided.
Line 3:	 Check	 this	 box	 if	 the	 company	 is	 a	 foreign	 insurer.	
Alien	insurers	are	considered	foreign	insurers,	unless	their	port	
of	 entry	 is	 Michigan,	 in	 which	 case	 the	 company	 is	 considered	
domestic	for	the	filing	of	this	return.
Line 4:	 Alien	 insurers,	 enter	 the	 two-letter	 postal	 code	 for	 the	
U.S.	state	that	is	your	port	of	entry.
Direct Premiums Written in Michigan
NOTE: For line 5 through line 13 and line 20 through
line 22, complete Column A to report Qualified Health
Insurance Policies and Column B to report all other
policies.
“Qualified	 health	 insurance	 policies”	 means	 policies	 written	
on	 risk	 located	 or	 residing	 in	 this	 state	 that	 are	 one	 of	 the	
following	types	of	policies:	
(a)	 Comprehensive	 major	 medical,	 regardless	 of	 whether	
the	 policy	 is	 eligible	 for	 a	 health	 savings	 account	 or	
purchased	on	the	health	insurance	marketplace.	
(b)	Student.	
(c)	Children’s	health	insurance	program.	
(d)	Medicaid.	
(e)	 Employer	 comprehensive,	 regardless	 of	 whether	
the	 policy	 is	 eligible	 for	 a	 health	 savings	 account	 or	
purchased	on	the	health	insurance	marketplace.	
(f)	Multiple	employer	associations	or	trusts	and	any	other	
employer	associations	and	trusts.

Address:	Enter	the	postal	address	for	this	taxpayer.

Qualified	 Health	 Insurance	 Policies	 are	 taxed	 at	 a	 special	 rate,	
determined	annually	using	a	statutory	formula.

City:	 Enter	 the	 city	 name	 for	 this	 taxpayer.	 DO	 NOT	
include	the	country	name	in	this	field.

Line 5:	 Enter	 all	 gross	 direct	 premiums	 written	 on	 property	 or	
risk	located	or	residing	in	Michigan.

State:	 Enter	 the	 two-letter	 state	 or	 province	 abbreviation.	
If	there	is	no	applicable	two-letter	abbreviation,	leave	this	
field	blank.

Line 6:	 Enter	 premiums	 on	 policies	 not	 taken	 to	 the	 extent	
these	premiums	were	included	in	line	5.

ZIP/Postal Code:	Enter	the	ZIP	Code	or	Postal	Code.

Line 7:	 Enter	 returned	 premiums	 on	 canceled	 policies	 to	 the	
extent	these	premiums	were	included	in	line	5.

Country Code:	 Enter	 the	 two-letter	 country	 code	
provided	in	this	tax	booklet.

8

Line 8:	 Enter	 receipts	 on	 sales	 of	 annuities	 to	 the	 extent	 these	
receipts	were	included	in	line	5.
Line 9:	 Enter	 receipts	 on	 reinsurance	 premiums	 assumed	 to	
the	extent	these	receipts	were	included	in	line	5,	and	only	if	tax	
was	paid	on	the	original	premiums.
DISABILITY INSURANCE EXEMPTION
Line 12:	 “Disability	 insurance”	 includes	 any	 policy	 or	 contract	
of	insurance	against	loss	resulting	from	sickness	or	from	bodily	
injury	or	death	by	accident,	or	both,	including	also	the	granting	
of	 specific	 hospital	 benefits	 and	 medical,	 surgical	 and	 sickcare	 benefits	 to	 any	 person,	 family	 or	 group,	 subject	 to	 certain	
exclusions.
The	 exclusion	 for	 disability	 insurance	 premiums	 does	 not	
include	 credit	 insurance	 or	 disability	 income	 insurance	
premiums.
Line 22, Column A:	Multiply	line	21	by	0.9477%.
Line 22, Column B:	Multiply	line	21	by	1.25	percent	(0.0125).
CREDITS
Line 24:	 Enter	 the	 amounts	 paid	 to	 the	 listed	 facilities	
or	 associations	 from	 January	 1,	 2023,	 to	 December	 31,	
2023,	 including	 special	 assessments.	 Net	 the	 amounts	 paid	
and	 refunds	 received	 during	 2023	 for	 the	 same	 facility	 or	
association.	 If	 refunds	 received	 exceed	 the	 amount	 paid	 in	 the	
year	for	the	same	facility	or	association,	enter	zero.
Line 24c:	 For	 tax	 years	 beginning	 on	 and	 after	 January	 1,	
2023,	 amounts	 paid	 to	 the	 Michigan	 Automobile	 Insurance	
Placement	 Facility	 (MAIPF)	 that	 are	 attributable	 to	 the	
assigned	 claims	 plan	 shall	 not	 be	 included	 in	 the	 calculation	 of	
this	credit.
Line 26:	 Enter	 the	 amount	 of	 Michigan	 Examination	 Fees	 or	
Regulatory	 Fees	 paid	 in	 2024	 (under	 Michigan	 Compiled	 Law	
500.224).
Line 29:	 If	 not	 claiming	 the	 CIT	 Historical	 Preservation	 Tax	
Credit,	carry	the	amount	from	line	28	to	line	29.
Line 30:	 Enter	 the	 Total	 Recapture	 of	 Certain	 Business	 Tax	
Credits	from	Form	4902.	Include	a	copy	of	Form	4902.
Retaliatory Instructions
For foreign and alien insurers only; domestic insurers skip
lines 32 through 46.
Do	 not	 mail	 this	 return	 with	 the	 Michigan	 Annual	 Financial	
Statement.
Foreign	 insurers	 must	 pay	 to	 Michigan	 the	 same	 type	 of	
obligation	 a	 similar	 Michigan	 insurer	 is	 required	 to	 pay	 in	 the	
company’s	 state	 of	 domicile.	 Enter	 all	 items	 that	 are	 required	
of	 a	 Michigan	 insurance	 company.	 Some	 taxes	 and	 obligations	
imposed	in	other	states	may	have	no	corresponding	requirement	
in	 Michigan;	 however,	 this	 does	 not	 relieve	 the	 foreign	 insurer	
from	the	obligation	of	computing	and	paying	the	correct	amount	
of	the	tax.
Do	 not	 include	 the	 following	 Michigan	 assessments,	
or	 comparable	 assessments	 in	 the	 company’s	 state	 of	
incorporation,	in	the	retaliatory	calculation:

9

•
•
•
•
•
•
•

Michigan	Worker’s	Compensation	Placement	Facility
Michigan	Basic	Property	Insurance	Association
Michigan	Automobile	Insurance	Placement	Facility
Property	and	Casualty	Guaranty	Association
Michigan	Life	and	Health	Insurance	Guaranty	Association
Catastrophic	Claims	Association
Assessment	 under	 Health	 Insurance	 Claims	 Assessment	 Act	
(HICAA).

Line 32:	 Enter	 the	 tax	 a	 Michigan	 company	 would	 pay	
to	 the	 taxpayer’s	 state	 of	 incorporation	 if	 it	 conducted	 the	
same	 amounts	 and	 types	 of	 business	 there	 as	 the	 taxpayer	
is	 conducting	 in	 Michigan.	 Attach	 a	 copy	 of	 the	 state	 of	
incorporation’s	 tax	 form	 on	 which	 this	 pro	 forma	 tax	 on	 the	
hypothetical	Michigan	company	was	calculated.
Lines 34 through 44:	 In	 column	 A,	 “State	 of	 Incorporation,”	
enter	 the	 amounts	 that	 would	 be	 paid	 by	 a	 hypothetical	
Michigan	 insurance	 company	 doing	 the	 same	 types	 and	
amounts	 of	 business	 in	 the	 taxpayer’s	 home	 state	 that	 the	
taxpayer	is	doing	in	Michigan.
Lines 39 and 41-44: In	column	B,	“Michigan,”	enter	the	actual	
amounts	paid	by	the	taxpayer	to	Michigan.
Line 44: Attach	a	detailed	schedule	of	assessments.
Line 46:	Subtract	line	45,	column	B,	from	line	45,	column	A.	If	
less	than	zero,	enter	zero.
PAYMENTS, REFUNDABLE CREDITS, AND TAX DUE
Line 49:	 Enter	 the	 total	 tax	 paid	 with	 the	 quarterly	 estimated	
tax	returns.	
Line 51:	 Enter	 here	 Michigan	 Tax	 withheld	 for	 deferred	
compensation	 plans,	 life	 insurance	 and/or	 lottery	 annuities	
issued	 to	 a	 business	 account	 number	 through	 MCL	 206.703(1).	
Taxpayers	 can	 enter	 the	 Michigan	 Tax	 withheld	 reported	 on	 the	
W-2G	and/or	1099R.
Also	 report	 any	 credit	 for	 the	 taxpayer’s	 allocated	 share	 of	
Michigan	 flow-through	 entity	 (FTE)	 tax	 levied	 on	 and	 paid	 by	
an	 electing	 flow-through	 entity.	 Such	 an	 electing	 flow-through	
entity	 should	 be	 indirectly	 owned	 by	 this	 taxpayer.	 Include	 a	
copy	 of	 the	 Schedule	 K-1	 with	 the	 Schedule	 K-1	 notes,	 or	 other	
supporting	 documentation	 received	 from	 the	 electing	 flowthrough	entity,	to	support	the	credit	claimed	on	this	line.
Line 52:	 The	 Worker’s	 Disability	 Supplemental	 Benefit	
(WDSB)	 Credit	 is	 available	 to	 an	 insurance	 company	 subject	
to	 the	 Worker’s	 Disability	 Compensation	 Act	 of	 1969.	 The	
credit	 is	 equal	 to	 the	 amount	 paid	 during	 that	 tax	 year	 by	 the	
insurance	 company	 pursuant	 to	 Section	 352	 of	 the	 act,	 as	
certified	by	the	director	of	the	Worker’s	Compensation	Agency,	
Department	 of	 Licensing	 and	 Regulatory	 Affairs	 (LARA),	
during	 the	 tax	 year.	 The	 amount	 of	 the	 credit	 is	 provided	 to	
taxpayers	 by	 LARA.	 For	 more	 information	 on	 WDSB	 credit	
eligibility,	 contact	 LARA,	 Workers’	 Compensation	 Agency,	 by	
phone	 at	 1-888-396-5041,	 by	 email	 at	 [email protected],	
or	visit	the	LARA	Web	site	at	www.michigan.gov/wca.
Line 55:	 If	 penalty	 and	 interest	 are	 owed	 for	 not	 filing	
estimated	 returns	 or	 for	 underestimating	 tax,	 complete	
the	 CIT Penalty and Interest Computation for Underpaid

Estimated Tax (Form	 4899),	 to	 compute	 penalty	 and	 interest	
due.	 If	 a	 taxpayer	 chooses	 not	 to	 file	 Form	 4899,	 Treasury	
will	 compute	 penalty	 and	 interest.	 (Form	 4899	 is	 available	 at	
www.michigan.gov/treasuryforms.)

Other Supporting Forms and Schedules

Line 56:	Refer	to	the	“Computing	Penalty	and	Interest”	section	
in	 Form	 4904	 to	 determine	 the	 annual	 return	 penalty	 rate	 and	
use	the	following	Overdue	Tax	Penalty	worksheet.

• Proof	 of	 payment	 for	 any	 items	 listed	 in	 the	 “Michigan”	
column	for	lines	40	through	43.
• Worker’s	 Disability	 Supplemental	 Benefit	 (WDSB)	
Certificate.

WORKSHEET – OVERDUE TAX PENALTY
A. Tax	due	from	Form	4905,	line	54	........
B. Late	or	insufficient	
payment	penalty	percentage	................
C. Multiply	line	A	by	line	B.....................
	

00
%
00

Carry	amount	from	line	C	to	Form	4905,	line	56.
Line 57:	Use	the	following	worksheet	to	calculate	Overdue	Tax	
Interest.

A.
B.
C.
D.
E.

WORKSHEET – OVERDUE TAX INTEREST
Tax	due	from	Form	4905,	line	54	........
Applicable	daily	interest	percentage		..
Number	of	days	return	was	past	due	...
Multiply	line	B	by	line	C		....................
Multiply	line	A	by	line	D		....................

The	following	forms	and	their	requested	attachments	should	be	
included	as	part	of	this	return,	as	applicable:

• California insurers	 must	 include	 Bureau	 of	 Fraudulent	
Claims	assessments.
• New York domiciled companies	 must	 file	 and	 pay	 a	
tentative	retaliatory	tax	to	Michigan	by	the	Michigan	annual	
return	 due	 date	 (March	 1).	 Form	 4905	 must	 be	 filed	 after	
the	 actual	 CT33	 is	 filed	 with	 New	 York.	 Transfer	 the	 CT33	
numbers	 onto	 the	 Form	 4905	 and	 attach	 a	 copy	 of	 the	 CT33	
to	substantiate	the	taxpayer’s	claim.

00
%
00

Carry	amount	from	line	E	to	Form	4905,	line	57.
NOTE:	 If	 the	 late	 period	 spans	 more	 than	 one	 interest	 rate	
period,	 divide	 the	 late	 period	 into	 the	 number	 of	 days	 in	 each	
of	 the	 interest	 rate	 periods	 identified	 under	 the	 “Computing	
Penalty	 and	 Interest”	 section	 in	 Form	 4904	 and	 apply	 the	
calculations	 in	 the	 Overdue	 Tax	 Interest	 worksheet	 separately	
to	 each	 portion	 of	 the	 late	 period.	 Combine	 these	 interest	
subtotals	and	carry	the	total	to	Form	4905,	line	57.
Line 59: If	 the	 amount	 of	 the	 tax	 overpayment,	 less	 any	
penalty	 and	 interest	 due	 on	 lines	 55,	 56	 and	 57,	 is	 less	 than	
zero,	enter	the	difference	(as	a	positive	number)	on	line	59.
NOTE:	 If	 an	 overpayment	 exists,	 a	 taxpayer	 must	 elect	 a	
refund	 of	 all	 or	 a	 portion	 of	 the	 amount	 and/or	 designate	 all	 or	
a	 portion	 of	 the	 overpayment	 to	 be	 used	 as	 an	 estimate	 for	 the	
next	CIT	tax	year.	Complete	lines	60	and	61	as	applicable.
Line 60:	 If	 the	 taxpayer	 anticipates	 a	 CIT	 or	 Retaliatory	 Tax	
liability	 in	 the	 filing	 period	 subsequent	 to	 this	 return,	 some	 or	
all	 of	 any	 overpayment	 from	 line	 59	 may	 be	 credited	 forward	
to	 the	 next	 tax	 year	 as	 an	 estimated	 payment.	 Enter	 the	 desired	
amount	to	use	as	an	estimate	for	the	next	CIT	tax	year.
Reminder:	 Taxpayers	 must	 sign	 and	 date	 returns.	 Tax	
preparers	 must	 provide	 a	 Preparer	 Taxpayer	 Identification	
Number	 (PTIN),	 FEIN	 or	 Social	 Security	 number	 (SSN),	 a	
business	name,	and	a	business	address	and	phone	number.

10