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2017 Tax Form 4642

Michigan taxpayers can quickly and easily checkoff their support for the Alzheimer’s Association vision of a world without Alzheimer’s.

When preparing your 2016 Michigan income taxes, complete Tax Form 4642 - 2016 Michigan Voluntary Contributions Schedule and donate $5, $10 or more directly from your Michigan Income Tax return to the Alzheimer’s Association - Michigan Chapters! If you are receiving a refund, this donation will be taken directly from your refund. If you are not receiving a refund, this donation will increase your tax due.

Contact Lindsay Brieschke, for questions.

Frequently Asked Questions

Since I am making this donation in 2017, does that mean I can apply it to my 2017 income tax return?
No, your donation will be considered a gift from the 2016 tax year.

If I want to submit my taxes on paper form, where can I get Tax Form 4642?
Click on thislink to download the form and submit with your taxes.

How do I make a donation if I am doing an electronic form or using tax software?
You will be able to fill out Tax Form 4642 to give a Voluntary Charitable Contribution toward the end of your electronic return. Please use the help options to locate this feature if it doesn’t come up automatically.

Is there a minimum or maximum amount that I can donate?
Yes, the minimum amount is $5. There is not a maximum amount.

Will I receive a receipt for my donation?
No, you will not receive a separate receipt. You should keep a copy of your tax forms as a receipt for your reference.

Tax Form 4624 lists "Alzheimer's Association of Michigan," is that the Greater Michigan Chapter?
The Alzheimer's Association of Michigan includes both our chapter, the Greater Michigan Chapter, and our sister chapter, Michigan Great Lakes. We will divide the donations between the two chapters.

If I make a donation through Tax Form 4642, what will my money support?
Your donation will support the programs and services provided by the two Michigan Alzheimer's Association chapters. This includes the 24/7 Helpline, educational programming, care consultations and other local programs across the state. One hundred percent of your donation will stay in the state of Michigan for programs for people affected by Alzheimer's disease in our state.

Will the Alzheimer’s Association know that I gave a donation?
All donations will be submitted through the Michigan Department of Treasury, and for privacy reasons, the Alzheimer’s Association will not be provided the names of who gave donations.

If I have more questions, who should I contact for answers?
Please contact Lindsay Brieschke, Director of Public Policy at




Alzheimer's Association

Our vision: A world without Alzheimer's disease®.
Formed in 1980, the Alzheimer's Association is the world's leading voluntary health organization in Alzheimer's care, support and research.