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PROTESTAPPEAL of a REDETERMINATION STATUS Michigan 2020-2023
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...Show details
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