Request for Income Information

This letter was sent because your income tax refund is being held for a garnishment as the result of a debt owed to a third party.

Either you or your spouse is liable for a debt. Complete, sign and submit the enclosed Income Allocation for Non Obligated Spouse (Form 743) to determine how much of the refund can be applied to the debt. If you previously submitted form 743 for a State of Michigan debt you must still complete and return this form. If the form is not completely and correctly filled out, signed by both spouses and returned within 4 weeks; the entire refund (if needed) will be applied to the debt.

The Department is unable to advise whether or not your form has been received. You should receive a response within 20 weeks after you submit your form.

Note: If the spouse is deceased, include a copy of the death certificate.