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Michigan State Income Tax Checkoff
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2016 Michigan Income 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.

  • Donate all or part of your Michigan income tax return to the Alzheimer’s Association.

  • 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.

Questions? Contact Samantha West at

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.

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.

If I want to submit my taxes on a paper form, what form should I use to make my donation?
Download here and submit Tax Form 4642 MICHIGAN Voluntary Contributions Schedule.

Where can I get tax form 4642 to attach to my 1040 Form?
You can download the form here: If you are completing your taxes electronically, it should be at the end of the electronic form.

Tax Form 4642 lists "Alzheimer's Association of Michigan". Is this the Alzheimer's Association, Greater Michigan Chapter or Alzheimer’s Association, Michigan Great Lakes Chapter?
The Alzheimer's Association of Michigan includes both chapters in the state of Michigan. Donations made will be divided between the two chapters.

If I make a donation through the tax checkoff, what will my money support?
Your donation will support the programs and services provided by the two local Alzheimer's Association chapters. This includes the 24/7 Helpline, educational programs, caregiver training, support groups, early stage Alzheimer's programming, care consultations, and 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.

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.

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 Samantha West, Communications Director 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.