04._Tax_Appeal_Petition_Form_Non-Property.582ede4d-ab70-43d5-9157-3055c6c6ffda.pdf
Regina Thompson, Petitioner V City Of Detroit, Respondent · 24-004045-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: Individual First Name Regina Thompson M.I. Last Name/Company Name Thompson Mailing Address (No., Street, P.O. Box or Rural Route) 19211 griggs City or Town Detroit State Michigan ZIP Code 48221 Telephone Number 3133402768 Fax Number E-mail Address Frazierfamily111@gmail.com Section 2: Petitioner’s Attorney/Authorized Representative’s Contact Information First Name Regina M.I. A Last Name Thompson Firm Name (if any) Address (No., Street, P.O. Box or Rural Route) 19211 griggs City or Town Detroit State Michigan ZIP Code 48221 Telephone Number 3133402768 Fax Number E-mail Address Frazierfamily111@gmail.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 My name is Regina Thompson, and I am the primary wage earner in my household. I am currently unemployed due to necessary medical leave following a surgical procedure. I have been off work since April 30, 2024, and remain unable to walk unaided, relying on crutches for mobility. My recovery is ongoing, and I continue to undergo medical treatment. Due to these health challenges, I am still unable to resume work at this time. 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 2393.00 Interest 117.66 Penalty 598.25 List the refund sought, if any: 3108.91 List your Contentions: Tax 2393.00 Interest 117.66 Penalty 598.25 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: Regina A Thompson /s/