Michigan Department of Treasury (Rev. 04-22), Page 1 of 2 Issued under authority of Public Act 281 of 1967, as amended. 2022 MICHIGAN Individual Income Tax Return MI-1040 Amended Return (Include Schedule AMD) Return is due April 18, 2023. Type or print in blue or black ink. 1. Filer’s First Name M.I. Last Name 2. Filer’s Full Social Security No. (Example: 123-45-6789) If a Joint Return, Spouse’s First Name M.I. Last Name 3. Spouse’s Full Social Security No. (Example: 123-45-6789) Home Address (Number, Street, or P.O. Box) City or Town State ZIP Code 4. School District Code (5 digits – see page 60) 5. STATE CAMPAIGN FUND Check if you (and/or your spouse, if a. Filer filing a joint return) want $3 of your taxes to go to this fund. This will not increase b. Spouse your tax or reduce your refund. 6. FARMERS, FISHERMEN, OR SEAFARERS Check this box if 2/3 of your income is from farming, fishing, or seafaring. 7. 2022 FILING STATUS. Check one. a. Single * If you check box “c,” complete line 3 and enter spouse’s full name b. Married filing jointly below: c. Married filing separately* 8. 2022 RESIDENCY STATUS. Check all that apply. a. Resident * If you check box “b” or “c,” you must complete b. Nonresident * and include Schedule NR. c. Part-Year Resident * 9. EXEMPTIONS. NOTE: If someone else can claim you as a dependent, check box 9e, enter 0 on line 9a and enter $1,500 on line 9e (see instr.). a. Number of exemptions (see instructions)............................................................. 9a. x $5,000 b. Number of individuals who qualify for one of the following special exemptions: deaf, blind, hemiplegic, paraplegic, quadriplegic, or totally and permanently disabled 9b. x $2,900 c. Number of qualified disabled veterans ................................................................. 9c. x $400 d. Number of Certificates of Stillbirth from MDHHS (see instructions) ..................... 9d. x $5,000 e. Claimed as dependent, see line 9 NOTE above .................................................. 9e. f. Add lines 9a, 9b, 9c, 9d and 9e. Enter here and on line 15 ............................................................................. 10. Adjusted Gross Income from your U.S. Form 1040 (see instructions) .................................................... 10. 11. Additions from Schedule 1, line 9. Include Schedule 1 ............................................................................ 11. 12. Total. Add lines 10 and 11.......................................................................................................................... 12. 13. Subtractions from Schedule 1, line 30. Include Schedule 1 .................................................................... 13. 14. Income subject to tax. Subtract line 13 from line 12. If line 13 is greater than line 12, enter “0” ............ 14. 15. Exemption allowance. Enter amount from line 9f or Schedule NR, line 19.............................................. 15. 16. Taxable income. Subtract line 15 from line 14. If line 15 is greater than line 14, enter “0” ...................... 16. 17. Tax. Multiply line 16 by 4.25% (0.0425) ..................................................................................................... 17. NON-REFUNDABLE CREDITS AMOUNT 18. Income Tax Imposed by government units outside Michigan. Include a copy of the return (see instructions)........................ 18a. 00 00 18b. 19. Michigan Historic Preservation Tax Credit (see instructions). 19a. 19b. 20. Income Tax. Subtract the sum of lines 18b and 19b from line 17. If the sum of lines 18b and 19b is greater than line 17, enter “0” ............................................................... 20. 9a. 9b. 9c. 9d. 9e. 9f. 00 00 00 00 00 00 00 00 00 00 00 00 00 00 CREDIT 00 00 00 + 0000 2022 05 01 27 4 Continue on page 2. This form cannot be processed if page 2 is not completed and included. Reset Form

00 00 00 00 00 00 2022 MI-1040, Page 2 of 2 Filer’s Full Social Security Number 21. Enter amount of Income Tax from line 20................................................................................................... 21. 22. Voluntary Contributions from Form 4642, line 6. Include Form 4642........................................................ 22. 23. USE TAX. Use tax due on Internet, mail order or other out-of-state purchases from Worksheet 1 (see instructions)................................................................................................................... 23. 24. Total Tax Liability. Add lines 21, 22 and 23 ................................................................................... 24. REFUNDABLE CREDITS AND PAYMENTS 25. Property Tax Credit. Include MI-1040CR or MI-1040CR-2 ..................................................................... 25. 26. Farmland Preservation Tax Credit. Include MI-1040CR-5..................................................................... 26. FEDERAL 27. Earned Income Tax Credit. Multiply line 27a by 6% (0.06) and enter result on line 27b............................................................ 27a. 00 27b. 28. Michigan Historic Preservation Tax Credit (refundable). Include Form 3581............................................ 28. 29. Credit for allocated share of tax paid by an electing flow-through entity (see instructions)........................ 29. 30. Michigan tax withheld from Schedule W, line 6. Include Schedule W (do not submit W-2s) ................. 30. 31. Estimated tax, extension payments and 2021 credit forward..................................................................... 31. 32. 2022 AMENDED RETURNS ONLY. Taxpayers completing an original 2022 return should skip to line 33. Amended returns must include Schedule AMD (see instructions). If you had a refund and/or credit forward on the original return, check box 32a and enter this amount as a 32a. negative number on line 32c. If you paid with the original return, check box 32b and enter the amount paid with the original return, plus 32b. any additional tax paid after filing, as a positive number on line 32c. Do not include interest or penalty. 33. Total refundable credits and payments. Add lines 25, 26, 27b, 28, 29, 30, 31 and 32c .................. 33. REFUND OR TAX DUE 34. If line 33 is less than line 24, subtract line 33 from line 24. If applicable, see instructions. 00 00 Include interest and penalty ......................... YOU OWE 34. 35. Overpayment. If line 33 is greater than line 24, subtract line 24 from line 33 ................................ 35. 36. Credit Forward. Amount of line 35 to be credited to your 2023 estimated tax for your 2023 tax return ... 32c. MICHIGAN 36. 37. Subtract line 36 from line 35.......................................................................................REFUND 37. 00 00 00 a. Routing Transit Number b. Account Number DIRECT DEPOSIT Deposit your refund directly to your financial 1. institution! See instructions and complete a, b and c. c. Type of Account Savings Checking 2. Deceased Taxpayer. If Filer and/or Spouse died after December 31, 2021, enter dates below. Preparer Certification. I declare under penalty of perjury that this return is based on all information of which I have any knowledge. ENTER DATE OF DEATH ONLY. Example: 04-15-2022 (MM-DD-YYYY) Preparer’s PTIN, FEIN or SSN Filer Spouse Preparer’s Name (print or type) 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. Filer’s Signature Date Preparer’s Signature Spouse’s Signature Date Preparer’s Business Name, Address and Telephone Number By checking this box, I authorize Treasury to discuss my return with my preparer. Refund, credit, or zero returns. Mail your return to: Michigan Department of Treasury, Lansing, MI 48956 Pay amount on line 34 (see instructions). Mail your check and return to: Michigan Department of Treasury, Lansing, MI 48929 + 0000 2022 05 02 27 2 00 00 00 00 00 00 00 00