Refund Request Form (1).pdf
Kristi Krey Revocable Trust And Mary Ann Van Lokeren, Trustee, Petitioner Vs. City Of Harbor Springs, Respondent · 25-003205-TT
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Page 1
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 MICHIGAN TAX TRIBUNAL REFUND REQUEST Payee Name: ______________________________________________________________ Payee Address: ____________________________________________________________ MTT Docket No:_________ Amount of Refund Requested:$_________________________ Reason for Refund: ☐Filing/Motion Fee Overpaid ☐Duplicate Docket ☐Other _____________________________________________________________ __________________________________________________________________ Payment Information: Docket Lookup Line # of Payment: ______________________________________________ Date of Payment:____________________________________________________________ Check #:___________________________________________________________________ Validation/Confirmation #:_____________________________________________________ Requestor’s Signature:_______________________________________________________ __________________________________________________________________________ For Tribunal Use Only: Computation of Refund Amount: Amount paid: $ ____________ Granted: ☐ Amount Due: $ ____________ Denied: ☐ Amount Refunded: $ ____________ Prepared by: _____ Date: ________________ Authorized by: _____ Date: ________________ Audited/Entered by: _____ Date: ________________ Refund Denied by: ______________________ Date: ________________ Honigman LLP 2290 First National Building, 660 Woodward Avenue, Detroit, MI 48226 25-003205 600 1 8/21/2025 25082139681278 /s/ Jackie J. Cook 600 600 600 JMB 08/29/2025