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 PROTESTAPPEAL of a REDETERMINATION STATUS Michigan 2020-2023

PROTESTAPPEAL of a REDETERMINATION STATUS Michigan 2020-2023

Use a uia 1028 2020 template to make your document workflow more streamlined.

INFORMATION Name and Address If business, enter DBA, Trade or Assumed Name Telephone Number Extension Fax Number FEIN Number UIA Account Number * E-mail Address PART 2: REPRESENTATIVE INFORMATION AND AUTHORIZATION DATES Your authorized representative may be an organization, firm, or individual. If your representative is not an individual, designate a contact person. Please ensure that you submit a separate form for each representative. Representative Name and Address Contact...
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