Michigan Free Printable Form 3799, Statement to Determine State of Domicile for 2017 Michigan Statement to Determine State of Domicile

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Statement to Determine State of Domicile
Form 3799, Statement to Determine State of Domicile

Reset Form Michigan Department of Treasury Form 3799 (Rev. 05-01) Statement to Determine State of Domicile This form is issued under authority of Michigan Administrative Rule 206.5. Filing of this form is voluntary. Without the necessary information, the Michigan Department of Treasury will assume the individual was Michigan resident. Instructions: Complete this form to clarify for the Michigan Department of Treasury your domicile for tax purposes. Michigan residents are subject to income tax on all taxable income from any source (MCL 206.110). You are a Michigan resident if your domicile is in Michigan. Your domicile is where you have your permanent home. It is the place you plan to return to whenever you go away. You may have several residences, but you can have only one domicile at a time (MCL 206.18). That domicile continues until a new permanent home is established. Once established, your domicile can only change when these three criteria are met: 1. you have a specific intent to abandon your old domicile, 2. you have a specific intent to acquire a new domicile, and 3. you are physically living in your new domicile. You must show specific proof of each of these criteria, Please answer each item below and provide attachments where requested. PART 1: GENERAL INFORMATION Name (first, middle, last) Social Security Number What address did you file your last Michigan Income Tax Return from? (Number, Street, City, State, and ZIP Code) What address did you file your last Federal Income Tax Return from? (Number, Street, City, State and ZIP Code) PART 2: SPECIFIC INTENT TO ABANDON YOUR OLD DOMICILE A. If you are employed, have you been transferred? Yes No If yes, how long do you expect to be at your new location? B. Have you ever held a Michigan driver’s license? Yes No If yes, what is its expiration date? _____________________________________ C. Are you registered to vote? Yes No If yes, where are you registered (city and state)? _____________________________________ D. Do you have a will? Yes No If yes, where will it be probated (state)? _____________________________________ E. What state is your car registered in? Yes No What is the year on your license plate? _____________________________________ F. Do you or your spouse own or rent a home in Michigan? Yes No If yes, what do you intend to do with this property? _____________________________________ Permanent Specify: __________ Years _____________________________________ PART 3: SPECIFIC INTENT TO ACQUIRE A NEW DOMICILE A. What is your intended address outside Michigan? (Number, Street, City, State and ZIP Code) B. Have you made a formal declaration of domicile in any other state? If yes, attach a copy of the declaration. Yes No C. Do you have a valid Driver’s license from another state? If yes, attach a copy. Yes No 3799, Page 2 D. Did you file a tax return in another state? If yes, attach of a copy of the return. Yes No PART 4: PHYSICALLY LOCATED IN YOUR NEW DOMICILE A. Are you married? Yes No If yes, will your spouse move to your new location? Yes No* B. Do you have dependents? Yes No If yes, will they move to your new location? Yes No* *If you answered no to either of these questions, attach an explanation. List the name(s) and location(s) (city, state) of institutions where you have savings and checking accounts or safe deposit boxs. Attach additional sheets if necessary. List the name(s) and location(s) (city, state) of any organizations that you belong to. PART 5: STATEMENT TO DETERMINE STATE OF DOMICILE Check one that applies. My domicile is no longer in Michigan as of (date) ________________________. On this date, I had the specific intent to abandon my Michigan domicile. I had the specific intent to acquire my new domicile outside Michigan, and I was actually physically present in my new domicile. I understand that I must file a Michigan income tax return as a part-year resident for the year of change. My domicile continues to be in Michigan. I understand that I must continue filing Michigan income tax returns as a resident. Signature Date
Extracted from PDF file 2016-michigan-form-3799.pdf, last modified January 2012

More about the Michigan Form 3799 Other TY 2016

We last updated the Statement to Determine State of Domicile in May 2017, so this is the latest version of Form 3799, fully updated for tax year 2016. You can download or print current or past-year PDFs of Form 3799 directly from TaxFormFinder. You can print other Michigan tax forms here.

Other Michigan Other Forms:

TaxFormFinder has an additional 97 Michigan income tax forms that you may need, plus all federal income tax forms.

Form Code Form Name
Form 151 Authorized Representative Declaration (Power of Attorney)
Form 3581 Historic Preservation Tax Credit
2856 (Book) Guidelines for the Michigan Homeowner's Principal Residence Exemption Program (no form)
Form 2105 Michigan Homestead Property Tax Credits for Separated or Divorced Taxpayers
Form 3174 Direct Deposit of Refund

Download all MI tax forms View all 98 Michigan Income Tax Forms


Form Sources:

Michigan usually releases forms for the current tax year between January and April. We last updated Michigan Form 3799 from the Department of Treasury in May 2017.

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Historical Past-Year Versions of Michigan Form 3799

We have a total of five past-year versions of Form 3799 in the TaxFormFinder archives, including for the previous tax year. Download past year versions of this tax form as PDFs here:


2016 Form 3799

Form 3799, Statement to Determine State of Domicile

2015 Form 3799

Form 3799, Statement to Determine State of Domicile

Form 3799, Statement to Determine State of Domicile 2014 Form 3799

Form 3799, Statement to Determine State of Domicile

Form 3799, Statement to Determine State of Domicile 2012 Form 3799

Form 3799, Statement to Determine State of Domicile

Form 3799, Statement to Determine State of Domicile 2011 Form 3799

Form 3799, Statement to Determine State of Domicile


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