Refund Request Form fillable.pdf
M & H LeBeau Holdings LLC, Petitioner Vs. Township Of Clinton, Respondent · 25-002450-TT
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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: ________________ Laura M. Hallahan 25-002450 $50.00 duplicate filing 8 10/13/2025 25101349526574 /s/ Laura M. Hallahan l