25-003346.pdf

Betty S Pafford Rlt, Petitioner V Township Of Forest, Respondent · 25-003346-TT

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RECEIVED 

SEP 2 6 2025 

i 

epgeed 

: 

STATE OF MICHIGAN 

MICHIGAN TAX TRIBUNAL 

GRETCHEN WHITMER 

DEPARTMENT OF LICENSING AND REGULATORY AFFAIRS 

MARLON I. BROWN, DPA 

AONERPR 

LANSING 

DIRECTOR 

bet aS, loftord CLT 

ioner(s) 

Tours hip of. Forest 

Request Date: pane 

Le 

FEE WAIVER REQUEST 

Instructions: Complete this form and file it with the Tribunal. 

I request a waiver of filing fees for the following reason (check only one of 1, 2, or 3): 

1. 

O1 receive the following type(s) of public assistance because of indigence: 

O Food Assistance Program through the State of Michigan (known as FAP or SNAP) 

x Medicaid (including Healthy Michigan, CHIP, and ESO) 

[OO Family Independence Program through State of Michigan (known as FIP or TANF) 

0 Women, Infants, and Children benefits (WIC) 

O Supplemental Security Income through the federal government (SSI) 

OO Other means-tested public assistance ____________________________ 

2. [1am represented by a legal services program, or 

| receive assistance from a law 

school clinic because of indigence. The name of the legal services program or law 

school elie is? 

es ce 

My gross household income is $/, 

7. 2 every Mon tw (week/two 

weeks/month/year) 

The number of people in my household is roi J 

My source of incomeis ___ 

SJ) 

___________________ 

List assets and their worth, such as bank accounts. If you 

eed more space, 

© 2h a 

separate sheet: rrr 

ion gb Lig OY Spee 

um “LST Canty 

List obligations and how 

fnuch you pay, such as rent or other oy If you need m 

space, attach a separate sheet: 2lee 

( 557% 

SP bed Loe 

BD aetna ______ © 

house phwel 230% 0m — LAaadtqcand fas 5,000 Qeq ut

DI 

{al 

(p 

ISON. 

i 

Mi 48463: 

60 

Lie 

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Tah 

i 

2% 

7 

ig 

& 

7 

2 

2

CRANE RASEREL 

Tr "Tio wel 

225 

PA 1b 

LT 

Michiq Av TAs Tuibwo. 

| 

611 W, Oth 5 

hansing 

Mich. 

48933 

SETHI 10TH 

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