Form 3739 "Eligible Purchaser Application to Defer Payment to Licensed Supplier" - Michigan

What Is Form 3739?

This is a legal form that was released by the Michigan Department of Treasury - a government authority operating within Michigan. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on July 1, 2009;
  • The latest edition provided by the Michigan Department of Treasury;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;

Download a fillable version of Form 3739 by clicking the link below or browse more documents and templates provided by the Michigan Department of Treasury.

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Download Form 3739 "Eligible Purchaser Application to Defer Payment to Licensed Supplier" - Michigan

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Michigan Department of Treasury
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3739 (Rev. 7-09)
Eligible Purchaser Application to Defer Payment to Licensed Supplier
P.A. 403 of 2000, as amended, allows an eligible purchaser to defer payment of the tax on motor fuel to licensed suppliers
until one business day before the motor fuel tax becomes due and payable to the state by the supplier. The supplier is
required to remit the tax on the 20th day of the month following the end of a reporting period. An eligible purchaser must
meet the following requirements to qualify for the election to defer payment:
1. An application to defer payment must be completed by the eligible purchaser and the supplier and forwarded to the
Michigan Department of Treasury for approval. The eligible purchaser must submit a separate application for each
supplier to whom they will be deferring payment of the tax.
2. Eligible purchasers must submit a financial statement with the application to defer payment. An applicant who does not
satisfy the Michigan Department of Treasury as to their financial responsibility will be required to secure a surety bond
or a cash deposit before a deferred plan will be approved. The maximum bond required cannot exceed three times the
estimated monthly tax liability.
3. The eligible purchaser’s payment of all taxes due to the supplier(s) shall be paid by electronic funds transfer on or before
one (1) business day prior to the due date of the tax return.
An Eligible Purchaser Application to Defer Payment must be reviewed and authorized by the Michigan Department
of Treasury. Upon official authorization, the deferred plan will take effect on the first day of the month following the
application approval.
At the election of the eligible purchaser, the licensed supplier must enter into a deferred payment plan; however, a
supplier may terminate this deferment plan if the eligible purchaser does not make timely payments to the supplier
as required by P.A. 403 of 2000, as amended. An eligible purchaser whose deferment plan is terminated by a
supplier and who has deferment plans with other suppliers will be immediately placed on a tax-paid basis with all
suppliers.
SUPPLIER
ELIGIBLE PURCHASER
Name
Name
FEIN or TR Number
FEIN or TR Number
Address (Street or RR#, City, State, ZIP)
Address (Street or RR#, City, State, ZIP)
Contact Person
Telephone Number
Contact Person
Telephone Number
Signature
Date
Signature
Date
Estimated Monthly Tax Payment to this Supplier $ ______________________________________
For approval Mail to:
Michigan Department of Treasury
Special Taxes Division
P.O. Box 30474
Lansing, Michigan 48909-7974
Once approved, a copy of the signed form will be returned to both the eligible purchaser and the supplier. Authorization will be effective on the first day
of the month after the application is approved.
Call (517) 636-4600 if you have any questions.
FOR TREASURY USE ONLY
Authorized Signature
Date
Approved
Denied
Effective Date
www.michigan.gov/treasury
Michigan Department of Treasury
Reset Form
3739 (Rev. 7-09)
Eligible Purchaser Application to Defer Payment to Licensed Supplier
P.A. 403 of 2000, as amended, allows an eligible purchaser to defer payment of the tax on motor fuel to licensed suppliers
until one business day before the motor fuel tax becomes due and payable to the state by the supplier. The supplier is
required to remit the tax on the 20th day of the month following the end of a reporting period. An eligible purchaser must
meet the following requirements to qualify for the election to defer payment:
1. An application to defer payment must be completed by the eligible purchaser and the supplier and forwarded to the
Michigan Department of Treasury for approval. The eligible purchaser must submit a separate application for each
supplier to whom they will be deferring payment of the tax.
2. Eligible purchasers must submit a financial statement with the application to defer payment. An applicant who does not
satisfy the Michigan Department of Treasury as to their financial responsibility will be required to secure a surety bond
or a cash deposit before a deferred plan will be approved. The maximum bond required cannot exceed three times the
estimated monthly tax liability.
3. The eligible purchaser’s payment of all taxes due to the supplier(s) shall be paid by electronic funds transfer on or before
one (1) business day prior to the due date of the tax return.
An Eligible Purchaser Application to Defer Payment must be reviewed and authorized by the Michigan Department
of Treasury. Upon official authorization, the deferred plan will take effect on the first day of the month following the
application approval.
At the election of the eligible purchaser, the licensed supplier must enter into a deferred payment plan; however, a
supplier may terminate this deferment plan if the eligible purchaser does not make timely payments to the supplier
as required by P.A. 403 of 2000, as amended. An eligible purchaser whose deferment plan is terminated by a
supplier and who has deferment plans with other suppliers will be immediately placed on a tax-paid basis with all
suppliers.
SUPPLIER
ELIGIBLE PURCHASER
Name
Name
FEIN or TR Number
FEIN or TR Number
Address (Street or RR#, City, State, ZIP)
Address (Street or RR#, City, State, ZIP)
Contact Person
Telephone Number
Contact Person
Telephone Number
Signature
Date
Signature
Date
Estimated Monthly Tax Payment to this Supplier $ ______________________________________
For approval Mail to:
Michigan Department of Treasury
Special Taxes Division
P.O. Box 30474
Lansing, Michigan 48909-7974
Once approved, a copy of the signed form will be returned to both the eligible purchaser and the supplier. Authorization will be effective on the first day
of the month after the application is approved.
Call (517) 636-4600 if you have any questions.
FOR TREASURY USE ONLY
Authorized Signature
Date
Approved
Denied
Effective Date
www.michigan.gov/treasury