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Michigan Department of Treasury
5156 (Rev. 05-15) Reset Form

Request for Tax Clearance Application
Issued under authority of Public Act 228 of 1975, as amended.

ReAson foR The RequesT

I am selling my business or business assets.
l Complete Part 1 and Part 4 ONLY

I am closing my business and my business is registered as a corporation with the Michigan Department of Licensing
and Regulatory Affairs.
l Complete Part 1, Part 2, and Part 4 ONLY

I have completed the sale of my business or business assets and require a tax clearance certificate.
l Complete Part 1, Part 3, and Part 4 ONLY

PART 1: GeneRAl InfoRmATIon — To be completed by ALL applicants.
Current Business or Corporation Name FEIN or TR Number

Previous Business or Corporation Name

Address City State ZIP Code

PART 2: CoRPoRATe DIssoluTIon oR WIThDRAWAl — To be completed by any business entity incorporated
through the Michigan Department of Licensing and Regulatory Affairs (LARA).

noTe: The date that the business is actually discontinued (below) should reflect the date on the Form 163 Notice of
Change or Discontinuance submitted to the Michigan Business Tax Registration Unit. If this form has not been submitted,
please complete and attach with this request. If the business and its FEIN number were not registered with the Michigan
Department of Treasury, please submit the last four years of Federal Business Tax Returns in place of the Form 163.
Corporate ID Number Assigned by LARA Date Incorporated with the State through LARA Date Business Actually Discontinued in Michigan

If this corporation had no tax liability or was not required to register with the Michigan Department of Treasury, provide a detailed explanation in the space below. Substantiate
with attachments:

Continue and sign on Page 2

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Form 5156, Page 2

PART 3: sAle of BusIness oR AsseTs — To be completed by any business (all types) that has sold all or part of the
business prior to submitting this application.

ImPoRTAnT: This is a request by any business entity that has sold most of its assets, but the business shell will remain
in place to continue filing tax returns (when due) until the business later determines whether it will file a Certificate of
Dissolution with the LARA Corporation Division.

Does the business operate under a trade name? ........................................................... Yes No

If yes, list the name it is doing business as. ....

Will you continue business activity after clearance under this FEIN or TR number? ...... Yes No

If no, have you submitted a Notice of Change or Discontinuance (Form 163)? ...... Yes No

If yes, date of discontinuance reported on Form 163 (MM-DD-YYYY)...........

If no, attach a completed Form 163 with this request.

Date of sale of business or business assets to another entity. ........................................

Is money being held in escrow pending receipt of a tax clearance? ............................... Yes No

If yes, how much is held in escrow? ........................................................................

PuRChAseR InfoRmATIon
Purchaser Business Name Purchaser FEIN

Purchaser Address City State ZIP Code

PART 4: CeRTIfICATIon AnD AuThoRIzATIon foR DIsClosuRe of InfoRmATIon
I declare under penalty of perjury that I am the owner, officer, or member of the business for which tax clearance is
requested and that the information entered is true.
Name (Print or Type) Title

Signature Date Telephone Number

Address City State ZIP Code

AuThoRIzATIon foR DIsClosuRe of TAx CleARAnCe InfoRmATIon (This is not a required section)

use this section to designate a third party to receive all tax clearance information for the business listed in Part 1.
The above signed authorizes the Michigan Department of Treasury, Tax Clearance Section, to release any and all tax
information and outstanding balances due for the purpose of tax clearance to the individual(s) listed below. This authorization
does not include signature power. This authorization is only valid for 90 days from the date of the signature above.
Name

Telephone Number Fax Number

Address City State ZIP Code

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Instructions for form 5156,

Request for Tax Clearance
to explain why no taxes were due and registration was not
Part 1: General Information – All fIelDs In
required. Include dates of operation and the nature of the
ThIs seCTIon musT Be ComPleTeD
business. You must include attachments with your application
NOTE: If you are selling a business but the sale has not to substantiate your position in order for it to be fully reviewed.
occurred, the Michigan Department of Treasury (Treasury)
will provide known or estimated tax liability for the purpose of Part 3: sale of Business or Assets has occurred
establishing a tax escrow. Once the sale is complete, submit a Complete this section if your business or any of the assets have
new request completing Part 1 and Part 3 to obtain a certificate been sold.
for the release of the escrowed funds.
NOTE: You must continue to file all returns by their due
Current Business or Corporation Name: Enter the date until you elect to file a dissolution or withdrawal. A Tax
legal business/corporation name. If the business is a sole Clearance Certificate for Sale of Business and/or Business
proprietorship, enter the owner’s name here, with the last name Assets is required when a bulk sale or transfer is made under
first. the Uniform Commercial Code. A Tax Clearance Certificate
Federal Employer Identification Number (FEIN) or for Sale of Business and/or Business Assets is granted after
Treasury Issued Account Number (TR): Enter the business’ Treasury determines that all Sales, Use, Income Withholding,
IRS-issued FEIN or Treasury-issued TR number. Cigarette, Motor Fuel, Single Business, Michigan Business,
and Corporate Income taxes have been paid for the period
Business Street Address/City/State/ZIP Code: Enter the of operation. When a Tax Clearance Certificate for Sale of
physical business address. (A PO Box is not acceptable in this Business and/or Business Assets is issued, money held in
field.) escrow is released and the purchaser is relieved of successor
liability. The seller agrees to keep all books and records of the
Part 2: Corporate Dissolution or Withdrawal
business until they are released by Treasury. The seller is liable
Complete this section if you are dissolving a domestic for all taxes due from the operation of the business during the
(Michigan) corporation or if you have a foreign corporation time specified by Treasury.
(incorporated outside Michigan) that is withdrawing from
Michigan. A corporation is any business entity that has filed Does the business operate under a trade name? If your
and incorporated with the Michigan Department of Licensing business operates under any name other than the legal
and Regulatory Affairs (LARA). corporation name, check (with an “X”) yes in the appropriate
box. On the next line, enter the trade name, assumed name, or
NOTE: A Tax Clearance Certificate must be requested from doing business as name. If your business only operates under
Treasury within 60 days of dissolution or withdrawal of its legal corporation name, check (with an “X”) no.
business from Michigan.
Are you continuing business activity after clearance
Corporate Identification Number: Enter the business’ under this FEIN or TR number? If you plan to continue
LARA-assigned Corporate Identification Number (CID). This to operate your business within the State of Michigan, check
number can be located on the annual statements filed with (with an “X”) yes in the appropriate box. If you do not plan to
LARA or online at www.michigan.gov/lara. continue operating, check (with an “X”) no. If you have already
Date Business Discontinued in Michigan: Enter the date submitted a Form 163 to the Registration Unit, enter the
your business ceased operations in Michigan. This date discontinuance date listed on that form. If you have yet to file
should reflect the date entered on the Notice of Change or Form 163 with the Registration Unit, attach a completed Form
Discontinuance (Form 163). If you have failed to complete and 163 with this application.
submit Form 163 to the Registration Unit, you must complete NOTE: The following items should ONLY be filled out if the
and remit Form 163 with this application. In the event your sale has occurred, not before.
business’ FEIN was never registered with Treasury, you must
include the last four years of Federal Returns for the business Date of Sale of Business or Business Assets to Another
in place of Form 163. Entity. Enter the date all or part of the business was sold.
Date Incorporated with the State of Michigan through Is money being held in escrow pending receipt of a Tax
LARA: Enter the date of incorporation. For additional Clearance Certificate? If money is being held in escrow from
information, go to LARA’s Web site: www.michigan.gov/lara. the sale, check (with an “X”) yes and enter the amount being
held.
If the corporation had no tax liability or was not required to
register with Treasury, provide a detailed explanation. In rare Business Name, Street Address, and FEIN of Purchaser.
cases, a corporation may not have had any tax liability or may Enter purchaser’s legal name, address, and FEIN.
not have registered for taxes with the State of Michigan. If
your business falls into this category, use the space provided

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Part 4: Certification and Authorization for 
Disclosure of Tax Clearance Information
NOTE:  All  fields  directly  under  the  Certification  must  be 
completed. If authorizing the disclosure of  information, all 
fields in that section must be completed as well.
This section must be completed for all requests. All requests 
must  be  submitted  by  an  owner,  officer,  or  member  of  the 
business.  By  completing  the  Certification,  you  are  declaring 
under penalty of perjury that all information entered is true.
Complete this section with your printed name, title, signature, 
daytime phone number, contact address, and the date in which 
the application was completed. 

submitting form 5156
Complete and mail this form to:
Michigan Department of Treasury
Tax Clearance Section
P.O. Box 30778
Lansing, MI 48909
For additional information, call (517) 636-5260, Monday 
through Friday (excluding holidays), from 8 a.m. to 5 p.m.

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