Form 3683 at a glance
What it is: Form 3683 (Rev. 8-09) of the Michigan Department of Treasury is the Payroll Service Provider Combined Power of Attorney Authorization and Corporate Officer Liability (COL) Certificate for Businesses.
Who signs: The Taxpayer's Power of Attorney Authorization must be signed by an authorized representative of the business.
Complete this form if you wish to appoint someone to represent your business to the State of Michigan for withholding tax matters.
A filled-in Form 3683 example: an LLC appoints a payroll service
How to fill out Form 3683, box by box
Taxpayer Name, Account No./Federal Employer ID No. (FEIN) and address
Enter the Taxpayer Name, Account No./Federal Employer ID No. (FEIN), Address (Street or RR#), City, State, ZIP Code, Contact Person and Telephone Number.
Payroll Service Name and Effective mo/day/yr
Under Payroll Service Name, enter the payroll service name, its Address (Street or RR#), City, State, ZIP Code, Contact Person and Telephone Number.
Enter the Effective mo/day/yr: from then the named payroll service provider/individual is authorized to represent your business and receive information in reference to all Treasury income tax withholding matters until you notify the Michigan Department of Treasury in writing that this Power of Attorney is revoked.
Taxpayer's Power of Attorney Authorization
Sign, enter the Date, and Type or Print Name and Title; the signer certifies the authority to execute this Power of Attorney.
CERTIFICATION and officer, member or partner liability
Corporations, partnerships, LLP's or LLC's must complete the CERTIFICATION section before this form can be processed: the Corporate Officer, Partner, or Member responsible for reporting and/or paying Michigan taxes signs, enters the Date, and Type or Print Title. This officer, member or partner certification must be resubmitted when there is a change in the individual responsible for filing and/or paying Michigan taxes.
Michigan Compiled Laws 205.27a(5) provides that if a corporation, limited liability company, limited liability partnership, partnership, or limited partnership liable for taxes administered under this act fails for any reason to file the required returns or pay the tax due, any of its officers, members, managers, or partners who the department determines, based on either an audit or an investigation, have control or supervision of, or responsibility for, making the returns or payments is personally liable for the failure.
More rules for Form 3683
The form is issued under authority of the Revenue Act, P.A. 122 of 1941, as amended, and filing is voluntary.
If you have any questions, please contact the Michigan Department of Treasury at (517) 636-4660.
Common questions about Form 3683
Where do I file it?
You may fax this form to (517) 636-4520, or mail to: Michigan Department of Treasury P.O. Box 30778 Lansing, MI 48909-8278.
Sources
[1] Form 3683 (Rev. 8-09), Payroll Service Provider Combined Power of Attorney Authorization and Corporate Officer Liability (COL) Certificate for Businesses, Michigan Department of Treasury (the Official source link on this page).