04._Tax_Appeal_Petition_Form_Non-Property.6daf1e6f-89da-43f8-924e-4ba54a4c9787.pdf
Green Bronco LLC, Petitioner Vs. Michigan Department Of Treasury, Respondent · 25-003857-TT
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STATE OF MICHIGAN GRETCHEN WHITMER GOVERNOR DEPARTMENT OF LICENSING AND REGULATORY AFFAIRS LANSING ORLENE HAWKS DIRECTOR TAX APPEAL PETITION FORM NON-PROPERTY TAX MTT DOCKET NO. Section 1: Petitioner’s Contact Information Filer Type: Organization First Name Diaz M.I. Last Name/Company Name Diaz Mailing Address (No., Street, P.O. Box or Rural Route) 21445 Hoover Road City or Town Warren State Michigan ZIP Code 48089 Telephone Number 602-295-3615 Fax Number 602-456-9909 E-mail Address mdiaz@brightroot.com Section 2: Petitioner’s Attorney/Authorized Representative’s Contact Information First Name Melissa M.I. Last Name Diaz Firm Name (if any) Address (No., Street, P.O. Box or Rural Route) 21445 Hoover Road City or Town Warren State Michigan ZIP Code 48089 Telephone Number 602-295-3615 Fax Number 602-456-9909 E-mail Address mdiaz@brightroot.com Pursuant to Michigan Tax Tribunal Rule (TTR) 277(3), you MUST submit a copy of the notice giving rise to the appeal (e.g. notice of action taken by the Michigan Department of Treasury) with this Small Claims Petition, if applicable. If you do not submit this document, you may be held in default.
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STATE OF MICHIGAN GRETCHEN WHITMER GOVERNOR DEPARTMENT OF LICENSING AND REGULATORY AFFAIRS LANSING ORLENE HAWKS DIRECTOR Section 3: Explain the Reason for this Appeal Following the State of Michigan’s audit of Green Bronco I (EIN ), the Department assessed additional excise and sales taxes. We timely requested an informal hearing on the excise tax assessment and successfully demonstrated that the underlying state-reported data was incorrect. The Department agreed with our position and the excise tax assessment was resolved accordingly. The Department relied on this same erroneous data to issue the additional sales tax assessment. As we have established that the underlying information used by the State is inaccurate, we appeal the sales tax assessment. We respectfully request that the Department allow our appeal to proceed and that the sales tax assessment be adjusted based on the proven inaccuracies in the State’s records. Section 4: Assessment Information Type of Tax Being Assessed: Assessment Number(s): Check all that are being appealed: Check what action prompted this appeal: (Check one) If “other,” explain: List the Amounts being levied: Tax 16681.37 Interest 2137.27 Penalty 0 List the refund sought, if any: 0 List your Contentions: Tax 16681.37 Interest 2137.27 Penalty 0 Fee Information A fee of $100.00 is required for the filing of a Non-Property Tax Appeal. Electronic Signature *Typing your name below will serve as your signature Petitioner or Attorney/Authorized Representative’s Signature: Melissa Diaz
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STATE OF MICHIGAN GRETCHEN WHITMER GOVERNOR DEPARTMENT OF LICENSING AND REGULATORY AFFAIRS LANSING ORLENE HAWKS DIRECTOR /s/