Fillable Form 2.: 2019 MICHIGAN Pension Schedule (Form 4884) (Michigan)

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Form 2.: 2019 MICHIGAN Pension Schedule (Form 4884) (Michigan)

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Michigan Department of Treasury
4884 (Rev. 05-19), Page 1 of 2
Include with Form MI-1040 and Schedule 1.
2019 MICHIGAN Pension Schedule (Form 4884)
If the ler and spouse (and deceased spouse from whom a surviving spouse is receiving benets) were born after December 31, 1952, STOP;
you are not entitled to a pension subtraction unless you receive retirement benets from employment with a governmental agency not covered
by the federal Social Security Act (SSA exempt employment) and meet additional conditions. Refer to the instructions for more details.
If the older of you or your spouse was born during the period January 1, 1946 through December 31, 1952, and reached age 67 on or before
December 31, 2019, do not complete this form. Instead, complete Schedule 1, line 23.
Failure to complete this form in its entirety will result in your pension subtraction being denied.
Attachment 23
Issued under authority of Public Act 281 of 1967, as amended. 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)
3.
If a Joint Return, Spouse’s First Name M.I. Last Name Spouse’s Full Social Security No. (Example: 123-45-6789)
PART 1: FILING INFORMATION
4. Primary Filer Year of Birth (ex. 19xx)
5. If a Joint Return, Spouse Year of Birth (ex. 19xx)
6
exempt employment.
7. If you are receiving retirement and pension benets from a deceased spouse who was born prior to January 1, 1953, complete lines 7a through 7c.
7a. Deceased Spouse Name 7b. Deceased Spouse Full Social Security No. 7c. Deceased Spouse Year of Birth (ex. 19xx)
.
Check here if you were born after 1952, were retired as of January 1, 2013, and received retirement benets from SSA
PART 2: RETIREMENT AND PENSION BENEFITS (see instructions)
Do not enter Social Security, military or railroad retirement benets here (see Schedule 1).
8.
Retirement and pension benets. List all that apply for ler (and spouse if ling jointly) including benets from a deceased spouse.
A B C D E F
Enter “X” for
Payer FEIN (from 1099-R)
Enter “X” for
Distribution Pension Amount
Deceased
Private or Public
(Example: 38-1234567)
Name of Payer
Spouse
Code Included in AGI
(see instructions)
00
00
00
00
00
00
00
00
00
00
Check here and complete the Michigan Pension Continuation Schedule (Form 4973) if you have more than ten sources of
Retirement and Pension Benets.
Continue on page 2. This form cannot be processed if page 2 is not completed and included.
+
You must also include a completed MI-1040 and Schedule 1 when ling Form 4884.
0000 2019 04 01 27 3
Reset Form
2019 Form 4884, Page 2 of 2
Filer’s Full Social Security Number (Example: 123-45-6789)
PART 3: To determine which section below to complete, review the questionnaire: “Which Section of Form 4884
Should I Complete?” in the MI-1040 book. Complete only one of the sections below.
SECTION A:
9.
Enter $52,808 if single or $105,615 if ling jointly. Reduce this amount by any military or railroad
retirement benets from Schedule 1, line 11 ................................................................................... 9. 00
10.
Enter total public retirement and pension benets (including public benets received from a
deceased spouse if deceased spouse was born prior to January 1, 1946 and died prior to 2019) . 10. 00
11.
Subtotal. Subtract line 10 from line 9. If line 10 is more than line 9, enter “0” .................................. 11. 00
12.
Enter total private retirement and pension benets (including private benets received from a
deceased spouse if deceased spouse was born prior to January 1, 1946 and died prior to 2019) . 12. 00
13.
If deceased spouse was born between January 1, 1946 and December 31, 1952 and died prior
to 2019, enter deceased spouse retirement and pension benets (maximum $20,000 if single or
$40,000 if ling jointly). ..................................................................................................................... 13. 00
14.
Add lines 12 and 13. ......................................................................................................................... 14. 00
15.
Enter the smaller of lines 11 or 14 .................................................................................................... 15. 00
16.
Total Retirement and Pension Benets Subtraction. Add lines 10 and 15. Carry this amount to
Schedule 1, line 24 ........................................................................................................................... 16. 00
SECTION B:
17.
Enter $52,808 if single or $105,615 if ling jointly. Reduce this amount by any military or railroad
retirement benets from Schedule 1, line 11 ................................................................................... 17. 00
18.
Enter public benets received from a deceased spouse born prior to January 1, 1946 and died
prior to 2019 ..................................................................................................................................... 18. 00
19.
Subtotal. Subtract line 18 from line 17. If line 18 is more than line 17, enter “0” ............................. 19. 00
20.
Enter private benets received from a deceased spouse born prior to January 1, 1946 and died
prior to 2019 ..................................................................................................................................... 20. 00
21.
Enter the smaller of lines 19 or 20 .................................................................................................... 21. 00
22.
Add lines 18 and 21. If you checked box 22C and/or 22F on Schedule 1, continue with line 23;
otherwise skip to line 26 ................................................................................................................... 22. 00
23.
Enter total ler and spouse retirement and pension benets ........................................................... 23. 00
24.
Maximum Allowable Pension Deduction. If you checked box 22C and/or 22F on Schedule 1, see
instructions ....................................................................................................................................... 24. 00
25.
Subtract line 22 from line 24. If line 22 is more than line 24, enter “0” ............................................. 25. 00
26.
If you checked box 22C and/or 22F on Schedule 1, enter the smaller of lines 23 or 25; otherwise
enter “0” ............................................................................................................................................ 26. 00
27.
Total Retirement and Pension Benets Subtraction. Add lines 22 and 26. Carry this amount to
Schedule 1, line 24 ........................................................................................................................... 27. 00
SECTION C:
28.
Total Retirement and Pension Benets Subtraction. Enter total retirement and pension
benets, including benets received from a deceased spouse who died prior to 2019 (maximum
$20,000 if single or $40,000 if ling jointly). If you checked box 22C and/or 22F on Schedule 1
or have military or railroad retirement benets reported on Schedule 1, line 11, see instructions.
Carry this amount to Schedule 1, line 24..........................................................................................
28. 00
SECTION D:
29.
Total Retirement and Pension Benets Subtraction. If you checked box 22C and/or 22F on
Schedule 1 and the older of you or your spouse was born on or after January 1, 1953 but before
January 2, 1958, enter retirement and pension benets you received, up to $15,000 per eligible
taxpayer. If you have military or railroad retirement benets reported on Schedule 1, line 11, see
instructions. Carry this amount to Schedule 1, line 24 ......................................................................
29. 00
+ 0000 2019 04 02 27 1
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Form 2.: 2019 MICHIGAN Pension Schedule (Form 4884) (Michigan)

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Completed 6 October 2020

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