Use this form to notify administrators of the correct amount of Michigan income tax to withhold from your pension or annuity payment(s). The insured’s name, address, Social Security number and marital status are required. The second page includes complete instructions.
The form can be completed online, then printed and signed. Click the link below and the form will open in a new window. Once completed and printed, clear the form and/or close the window.
You may mail or deliver the signed and witnessed form to your agent or to the address below:
Farm Bureau Life Insurance Company of Michigan
7373 W. Saginaw Hwy., PO Box 30200
Lansing, MI 48909-7700
Withholding Certificate for Michigan Pension or Annuity Payments
Payout Annuity Withholding Election