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Fill and Sign the Cc 79 Claim of Appeal on Application for Michigan Courts Form

Fill and Sign the Cc 79 Claim of Appeal on Application for Michigan Courts Form

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1. I appeal the a. statement of statutory disqualification as provided by the county clerk under MCL 28.425b(1 1) because: (Specify the reasons on a separate sheet. Attach supporting documentation.) b. failure to provide a receipt under MCL 28.425b(1) by the county clerk. MCL 28.425b(9) by Name of entity alleged to have failed to provide receipt . MCL 28.425l(3) by the Michigan State Police. county clerk. c. failure of the county clerk to issue a license to a carry a concealed pistol. The application filed on Date complied with MCL 28.425b(1), (5), and (9). d. failure of the county clerk to reinstate my license under MCL 28.428(2). 2. I am filing this appeal in the circuit court of the county in which I reside. Date Appellant/Attorney signature REQUEST FOR CERTIFIED RECORD I request that the county clerk send a certified copy of the record to the Circuit court number or name of county Circuit Court. CERTIFICATE OF MAILING I certify that on this date I served a copy of this claim of appeal on all parties by first-class mail addressed to their last-known addresses as defined by MCR 2.107(C)(3). Date Signature CLAIM OF APPEAL /s/ /s/ Approved, SCAOOriginal - Court 1st copy - Appellee 2nd copy - Appellant 3rd copy - Return Additional copies as needed Court telephone no. Court address Appellant

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