24-002360 FTA_Redacted.pdf

Jackson Mortgage Consulting, LLC, Petitioner V City Of Detroit, Respondent · 25-003290-TT

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Text extracted from the reviewed PDF, organized by page. OCR and reading order may contain errors; confirm details in the PDF below.

2/23/2024 10:00 AM  

 

• Printed by [H80504] at 12/23/2024 11:22 AM

Page 1 of 4   

AFTER VISIT SUMMARY

1.

2.

3.

4.

5.

6.

No change in medications at this time for memory and moods. 

Agree with respite care assistance with getting help into the home to 

work with Lillie as well as looking into day programs in the new year 

if approved for financial help. 

Recommend busy blankets or fidget toys to keep her hands busy. 

Overall strategy for treatment includes reducing burden from 

medical co-morbidities and increasing cognitive reserve through 

modification of lifestyle factors. 

Mirtazapine dosing deferred to PCP for management. 

Follow up in 6 months-1 year. Contact us (Center for Cognitive 

health) sooner if needed - through MyChart or via phone number 

248-661-6466.

 

 

Accurate as of December 23, 2024 11:22 AM.

See the medication list below for HOW to take these 

medications

You currently have no upcoming appointments scheduled.

If you need to change or cancel any appointment, call the department 

number listed for your upcoming appointment(s). 

 

 

Today's medication changes

 

What's Next

as of 12/23/2024

Problem List

from Jennifer Kuc, FNP

Instructions

You saw 

 on 

Monday December 23, 2024 for: 

CCH. The following issue was 

addressed: Moderate vascular 

dementia with mood 

disturbance.

 

 

 

 

 

160/76

Blood 

Pressure

 

23.56

BMI

 

133 lb

Weight

 

5' 3"

Height

 

85

Pulse

View your After Visit Summary and more 

online at https://mychart.hfhs.org/

mychart/.

MyChart

Today's Visit

nted by [H80504] at 12/23/2024 11:22 AM

Page 2 of 4   

Problem List (continued) as of 12/23/2024

Never done

Overdue since 5/25/1988

Never done

Overdue since 10/16/2021

Overdue since 12/30/2021

Overdue since 4/19/2022

Never done

Overdue since 9/1/2024

Overdue since 9/1/2024

BMI/BMI PERCENTILE ANNUAL MEASUREMENT (Yearly)

Next due on 12/23/2025

Adult Tdap/Td Vaccine (Every 10 Years)

Next due on 9/1/2027

Pneumococcal Vaccine Age 65+

Completed

At Henry Ford, we want you to have the very best patient experience. You may receive a survey.  Please take the time to 

tell us about your experience

Health Maintenance Summary - The Due Dates listed are 

recommended guidelines.

Survey Reminder

Full history report not available

Allergies as of 12/23/2024

Printed by [H80504] at 12/23/2024 11:22 AM

Page 3 of 4   

 suggestion 

 It is important to maintain an accurate medication list. Bring your medication list to any future health care visits 

and carry a copy in the event of emergency situations. If you have any questions, ask your nurse or doctor.

Morning Afternoon Evening

Bedtime

As 

Needed Any Time

1 

capsule

 

Take 1 tablet (10 mg) every morning after 

breakfast.

1 tablet

1 tablet

1 tablet

1 tablet

 

1 (ONE) TABLET ONCE DAILY HALF AN HOUR 

BEFORE BED

1 tablet

1 tablet

 

Your Medication List

as of December 23, 2024 11:22 AM

Your Medication List

rinted by [H80504] at 12/23/2024 11:22 AM

Page 4 of 4   

Your Medication List (continued) as of December 23, 2024 11:22 AM

Morning Afternoon Evening

Bedtime

As 

Needed Any Time

 

1 tablet

 

HEPARIN - 2 TAB DAILY UNTIL DONE/NO REFILLS

1 tablet

 

Education & Instructions

MEDICAL POWER OF ATTORNEY 

IMPORTANT INFORMATION 

IE 

IN TRT YOU REVIEW THE FOLLOWING INFORMATION BEFORE YOU SIGN 

ea 

{ENT. READ THE INFORMATION CAREFULLY AND SEEK GUIDANCE FROM A 

ems rR PROFESSIONAL OR ATTORNEY IF YOU DO NOT UNDERSTAND ANY OF 

By Signing this document, you are giving authority to the person you are designating as your agent to 

make medical decisions on your behalf. Medical decisions can include any medical service, treatment, 

medical procedure, diagnosis or treat both mental and physical conditions. Your agent will be able to 

aa with the same authority you would have if you were able to act for yourself and will have the 

authority to consent and refuse to consent to medical treatment including decisions about 

withdrawing or withholding life-sustaining treatment. It is, therefore, important that you know and 

must your agent and that your agent is aware of your preferences for healthcare treatment. 

Even after you sign this document, you will still be able to make your healthcare decisions assuming 

you are still considered mentally competent. Your agent cannot act on your behalf until your physician 

has determined that you are no longer physically or mentally able to make medical decisions unless 

otherwise stated in this document. 

The person you choose as your agent must be at least 18 years old and someone that you trust with your 

healthcare. Your agent is not liable for any decisions they make on your behalf, as long as those 

decisions were made in good faith. You should make sure that you have chosen an agent who wants to 

take on the role of agent. Discuss your medical preferences with your agent so they are aware of your 

wishes. Review this document with your agent so they are aware of their role. You also may choose up 

to two alternate agents in case your main agent is unavailable to act. Your alternate agent(s) should also 

be over 18 and aware of your preferences. 

You may revoke this document at any time while you are still competent to do so. You may revoke it by 

telling your medical provider and your agent that you are revoking the document or you may provide 

them a written revocation (recommended). If you execute another power of attorney later, that will 

have the effect of revoking this one. 

Page 1

L, Lillie B Wynn, of 4196 W Outer Drive, Detroit, Michigan, 48221 (hereinafter known as the 

“Principal ) hereby appoint Thadaus S Jackson of 4196 

W Outer Drive, Detroit, Michigan, 48221 

(hereinafter known as the “Agent”) as my Agent to make any and all medical decisions on my behalf, 

except to the extent that I limit in this document. My Agent can be reached at the following contact 

information: 

Phone number: (720) 499-7205 

Email address: tjpinnocle@gmail.com 

0 

F 

RN, 

AGE 

S 

1f my Agent appointed above is unable or unwilling to serve, I appoint the following person(s) to serve 

as Agent(s) in the order set forth below with the authority to make health care decisions on my behalf 

as provided herein: 

Alternate Agent #1 

Bemetta A Kyles-Hankins of 4196 W Outer Dr, Detroit, Michigan, 48221 can be best reached at the 

following phone number: (313) 717-4477. 

If my main Agent, Thadaus S J ackson, and Alternate Agent #1, Bernetta A Kyles-Hankins, are unable 

or unwilling to serve, there shall be no other individuals authorized to make medical decisions on my 

behalf. 

: 

LIMITATIONS 

OF 

AGENT 

Initial 

BY) 

- The Agent shall not have any limitations to the medical decision making powers they may 

make on my behalf. Therefore I acknowledge that the Agent shall have the right to provide, withhold, 

or withdraw artificial nutrition and hydration and all other forms of health care to keep me alive. 

) FIN 

- I intend for my Agent to be treated as I would with respect to my rights regarding the use 

and disclosure of my individually identifiable health information or medical records. This release 

authority applies to information governed by the Health Insurance Portability and Accountability Act 

(HIPAA) of 1996, 42 USC 1320d, 45 CFR 160-164. 

DURATION 

Unless stated otherwise herein, this document shall remain in effect until I revoke it. I understand that I 

cannot revoke this document if I am considered incompetent to make my own decisions. 

Initial 

Page 2

\ nN 

- This document shall not have an end date and shall terminate upon revocation, a new 

medical power of attomey, or my death. 

WHEN MY AGENT'S AUTHORITY BECOMES EFFECTIVE 

My Agent's authority becomes effective: 

Initial 

Lou - Immediately to make health care decisions on my behalf. 

AGENT'S OBLIGATION 

My Agent shall make healthcare decisions for me in accordance with this power of attorney for 

healthcare, any instructions I give in Part II of this form, and my other wishes to the extent known to 

my Agent. To the extent my wishes are unknown, my Agent shall make healthcare decisions for me in 

accordance with what my Agent determines to be in my best interest. In determining my best interest, 

my Agent shall consider my personal values to the extent known to my Agent. 

AGENT'S POST- 

ORITY 

Initial 

Lu 

- My Agent is authorized to make anatomical gifts, authorize an autopsy, and direct 

disposition of my remains, except as I state here or in Part 3 of this form. 

PRIOR 

MEDICAL 

POWER OF 

(0) 

Y 

By signing this document, I hereby revoke any and all prior medical powers of attorney that I may have 

executed. 

PART II. 

LIVING 

WILL 

Initial 

¥ oy, 

-1, Lillie B Wynn, declare to include this Living Will as part of my Medical Power of 

Attomney Form. 

-OF- 

SI 

1 direct that my healthcare providers and others involved in my care provide, withhold, or withdraw 

treatment in accordance with the choice I have initialed below: 

Initial 

Page 3 

a 

a J 

er EE

Lu) 

- I choose not to prolong life if I have an incurable and irreversible condition that will result in 

my death within a relatively short time, or if I become unconscious and, to a reasonable degree of 

medical certainty, I will not regain consciousness, or the likely risks and burdens of treatment would 

outweigh the expected benefits. 

RELIEF FROM PAIN 

Initial 

LoS 

- With regard to pain, I direct that treatment for alleviation of pain or discomfort be provided 

at all times, even if it hastens my death. 

OTHER WISHES 

Initial 

Les. - I would like to add the following: Absolutely no blood transfusions or blood fractions of any 

kind, under any circumstances, are to be administered to me. Alternative methods are acceptable and 

must be discussed with my representative under this Power of Attorney. 

PART ITI. DONATION OF ORGANS 

Initial 

Law. 1 do not wish to donate any of my organs after my death. 

PART IV. PRIMARY CARE PHYSICIAN 

L, Lillie 

B Wynn, do not wish to enter my Primary Care Physician's information. 

ORIGINAL 

AND COPIES OF THIS DOCUMENT 

This original document and/or copies shall be kept at the following locations: Copies will be held with 

my other daughter, Bernetta 

A Kyles-Hankins, and various Hospitals or Physicians as necessary. 

GO 

ING L 

This document shall be governed under the laws in the State of Michigan. 

EXECUTION 

Principal’s Signature Ld le. 2 . Lh ae, 

Lillie 

B Wynn 

+. 

Page 4

Agent’s Signa 

Thadaus S Jackson 

Page 5

WITNESS STATEMENT & ACKNOWLEDGMENT 

Iam not the person appointed as agent or successor agent in this medical power of attorney. I am not 

related to Lillie 

B Wynn by blood or marriage. I am not entitled to any portion of their estate, nor do I 

have any claim against their estate. I am not the attending physician of Lillie 

B Wynn or an employee 

of the attending physician. I am not involved in providing direct patient care to Lillie 

B Wynn and not 

an officer, director, partner, or business office employee of the healthcare facility or of any parent 

organization of the healthcare facility. 

WITNESS #1 

Signature: 

22, /.. pAZZ 

Print Name: 37 24 Corttny | 

Date: & “8 -2°2% 

Address: 

2-9 920 Grand parc Qr wo rlew m=gfeq> 

‘WITNESS 

#2 

isd 

Print Name: 

Lewy 

fore 

Date: 

WH, [fois 

nites: [7678 ire 

SF. LeAboi lM #5234 

Page 6

STATE OF MICHIGAN

GRETCHEN WHITMER

GOVERNOR

DEPARTMENT OF LICENSING AND REGULATORY AFFAIRS

LANSING

MARLON I. BROWN, DPA

DIRECTOR

MICHIGAN TAX TRIBUNAL · 611 W. OTTAWA ST., LANSING, MI 48933 · 517-335-9760

PO BOX 30232, LANSING, MI 48909 · Other Carriers: 2407 N. GRAND RIVER AVE., LANSING, MI 48906

Jackson Mortgage Consulting,LLC,

Petitioner, MICHIGAN TAX TRIBUNAL

 SMALL CLAIMS DIVISION

v

MTT Docket No. 24-002360

City of Detroit,

Respondent.

ORDER OF DEFAULT

The Tribunal has reviewed the file in this case and finds that Petitioner failed to appear 

for the duly-noticed hearing scheduled for August 21, 2025. Thus, this case is subject 

to dismissal or a default hearing.1 Prior to dismissal or the scheduling of a default 

hearing, however, the Tribunal finds that placing the absent party in default and ordering 

an explanation and documentation justifying the absence at the proceeding is 

appropriate.2 Therefore,

IT IS ORDERED that the absent party is HELD IN DEFAULT.

IT IS FURTHER ORDERED that the defaulted party shall submit information and 

documentation as directed above. The response must be filed with the Tribunal and 

served on the opposing party or the opposing party’s authorized representative within 

14 days of entry of this order.3 

Failure to comply with this order may result in dismissal of this case or the scheduling of 

a default hearing, as provided by TTR 237.

By______________________________

Entered: August 25, 2025

 Patricia L. Halm, Tribunal Chair

1 See TTR 247 & TTR 275.

2 See TTR 231 and See Grimm v Department of Treasury, 291 Mich App 140 (2010).

3 “A submission by mail is considered filed on the date indicated by the United States Postal Service 

postmark on the envelope containing the submission. A submission without a postmark or with an illegible 

postmark is considered filed on the date the submission is received by the tribunal. A submission by 

commercial delivery service is considered filed on the date the submission is given to the commercial 

service for delivery to the tribunal as indicated by the receipt date on the package containing the 

submission. A submission by personal service is considered filed on the date the submission is received. 

A submission through the tribunal’s e-filing system by 11:59 p.m. on a business day is considered filed on 

that business day. A submission by email to the email address designated by the tribunal by 11:59 p.m. 

on a business day is considered filed on that business day. A submission on a Saturday, a Sunday, or a 

holiday is considered filed on the following business day, as provided by section 35a of the tax tribunal 

act, MCL 205.735a.” TTR 225(5).

MTT Docket No. 24-002360 

Page 2 of 2

PROOF OF SERVICE

I certify that a copy of the foregoing was sent on the entry date indicated above to the 

parties or their attorneys or authorized representatives, if any, utilizing either the mailing 

or email addresses on file, as provided by those parties, attorneys, or authorized 

representatives.

By: Tribunal Clerk

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