Refund-Request-Form-fillable.pdf
Johnny Yee Petitioner V City Of Kalamazoo Respondent · 26-001461-TT
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STA TATE TE OF MICHIGAN GR GRETCHEN WHITMER DEPARTMENT O OF LI LICENSING AND R REGULATORY AFFAIRS MARLON I. BROWN, DPA GOV OVERNOR OR L DIRECTOR TOR ANSING MICHIG CHIGAN N TAX TRI RIBUNAL UNAL · 611 W. OTTAWA ST., LANSI NSING NG, MI 48933 · 517-335-9 -9760 PO BOX 30232, LANSI NSING NG, MI 48909 · Other Ca Carririers: 2407 N. N. GRAND RAND RIVER AVE., LANS NSING NG, MI 48906 MICHIGAN TAX TRIBUNAL REFUND REQUEST Payee Name: Payee Address: ______________________________________________________________ ____________________________________________________________ _______________________ ___________ MTT Docket No: Amount of Refund Requested: $ Reason for Refund: _____________________________________________________________ __________________________________________________________________ Payment Information: ☐Filing/Motion Fee Overpaid ☐Duplicate Docket ☐Other _____________________________________________ ___________________________________________________________ ___________________________________________________________________ _____________________________________________________ _______________________________________________________ _ _ _________________________________________________________________________ Check #: Validation/Confirmation #: Requestor’s Signature: Date of Payment: Docket Lookup Line # of Payment: For Tribunal Use Only: Computation of Refund Amount: _____________________ ______________________ ______________________ ___________________________ Granted: Amount Due: $ Amount Refunded: $ Prepared by:_ Date: $_ Amount paid: ☐ Denied: ☐ __________________________ Date: Authorized by:_ ______________________ Date: Audited/Entered by:_ _______________________ ________________ Refund Denied by:_ Date: Johnny Yee 3641 Whicker Pointe Kalamazoo MI 49006 26-001461 75.00 Line #1 5/26/2026 26052686965458 Johnny Yee