ial Security No.
Security No. (EFiler’s Full Soci le: 123-45-6789)
Spouse’s Full
Last Name
Last Name M.I.
If a Joint Return, Spouse’s First Name
Filer’s First Name
Michigan Department of Treasury Issued under authority of Public Act 281 of 1967, as amended.
4642 (Rev. 05-20)
2020 MICHIGAN Voluntary Contributions Schedule
INSTRUCTIONS: 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 specic 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 the reverse side of this form. Include
with Form MI-1040.
Type or print in blue or black ink.
Attachment 18
al xamp
Soc (Example: 123-45-6789)
A. B. C. Other Amount D. Total Contribution
(greater than $10)
1. American Red Cross Michigan Fund ..........
2. Animal Welfare Fund...................................
Children’s Trust Fund - Prevent Child
Abuse Michigan...........................................
4. Military Family Relief Fund ..........................
5. United Way Fund.........................................
6. Add column D, lines 1 through 5. Enter total of column D here and carry amount to your MI-1040, line 22........ 6.
This form must be included with your MI-1040 to ensure your contributions are properly credited to the designated fund(s).
+ 0000 2020 82 01 27 6
Reset Form
2020 Form 4642, Page 2
Instructions for Form 4642, Voluntary Contributions Schedule
Michigan taxpayers can contribute $5, $10, or more to any of the following funds on the Voluntary Contributions 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 suering 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 nations 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 nd 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
(MDARD) oers grants to Michigans registered animal shelters
to help support spaying and neutering programs for shelter
dogs and cats up for adoption. Grants also help support many
anti-cruelty and proper care programs around the state. Shelters
also use grant monies from your generous donations to help care
for animals that are seized as part of animal cruelty cases.
Children’s Trust Fund - Prevent Child Abuse
The Childrens Trust Fund (CTF) supports services throughout
Michigan to prevent child abuse and neglect. CTF funds home
visitation services; respite care; services for families with
incarcerated family members; and parenting education and
support. CTF supports a statewide network of local Child Abuse
and Neglect Prevention Councils. Examples of local Council
work are teaching professionals about mandated reporting;
teaching parents and caregivers about infant head trauma
prevention and infant safe sleep practices; and establishing baby
pantries to provide diapers, formula, and clothing. In the coming
year, CTF and its local Councils will lead statewide eorts to
build local responses to the opioid crisis.
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.
United Way Fund
United Way ghts for the health, education, and nancial
stability of every person in every community. By
contributing to the United Way Fund, youre 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 were 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.