Mathis_Redacted.pdf

Michelle R Mathis Petitioner V Township Of Mt Morris Respondent · 26-000684-TT

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Michigan Jer i:iment of Treasury 

4 @ 

EY 

618 (Rev. 12-25 

Petition to Board of Review 

L-4035 

This form is issued under the authority of P.A. 206 of 1893, as amended. Filing is voluntary, however you may not appeal to the Michigan Tax Tribunal 

unless you first protest to the Board of Review, except when the property is classified as commercial real, industrial real, or developmental real. You may 

not appeal property classification to the State Tax Commission unless you first protest to the Board of Review. 

JE COMPLETED BY OWNER OR OWNER'S AGENT 

wwner's Name (Please Print or Type) 

Petitioner's Name (If Other than Owner. Please Print or Type) 

MATHIS, MICHELLE 

Township or City 

County 

Year of Appeal 

MT. MORRIS TOWNSHIP 

Genesee 

262 

The undersigned protests the assessed value and/or the tentative taxable value and/or the property classification and/or the qualified agricultural property exemption of 

the following described property: 

Property Identified (Parcel code required. Property address & legal description optional) 

: 

14-34-577-109 

LOTS 196 197 & 198 WASHINGTON PARK SUB (74) 

3065 ROANOKE ST 

Protested Item 

§) 

Assessed Value 

Tentative 

[J Taxable Status 

[J 

Classification 

O 

Qualifed Agricultural 

~ 

. 

Taxable Value 

(exemption) 

Property Exemption 

1. PROTEST OF ASSESSMENT 

Complete this section for a protest of assessed value 

, including assessed value changes associated with exempt status and denied or late filed personal 

property forms. 

Assessed Amount 

Owner's 

Egtimate 

2 0 

Value a Value) 

25,600 

Ve 

2. PROTEST OF TAXABLE VALUE 

Complete this section for a protest of Taxable value 

REASON: 

[0 

value of Losses 

[1 

Value of Additions 

” Poverty Exemption 

[0 

Uncapping % 

ROTEST OF CLASSIFICATION 

Ti 

Complete this section for a request to change the classification. The Board of Review must make their decision regarding classification in accordance with section 211.34c of the 

Michigan Compiled Laws. The Board of Review shall not be influenced by the effect that a particular classification has on that property's status as a homeowner's principal residence 

or qualified agricultural property. 

Classification of property on this year's assessment roll: 

401 

Classification should be: (Please check one of the following) 

[0 

Agricultural 

[J Industrial 

[J Timber Cutover 

[] Utility (Personal Property Only) 

O 

commercial 

0 Residential 

pevelopmental 

4. PROTEST OF EXEMPTION FOR QUALIFIED AGRICULTURAL PROPERTY 

If the assessor has denied or changed the percentage of the exemption from the 18 mills of local school operating tax for qualified agricultural property, the owner may appeal this 

action to the March Board of Review. THE BOARD OF REVIEW HAS NO AUTHORITY TO CONSIDER OR ACT UPON THE EXEMPTION FROM THE 18 SCHOOL OPERATING 

MILLS FOR HOMEOWNER'S PRINCIPAL RESIDENCE PROPERTIES. 

Percent qualified agricultural exemption granted by assessor: (Enter 0 if exemption is denied) 

[Percent qualified agricultural exemption requested by Owner: (Enter 100 if full 

exemption requested) 

REASON FOR PROTEST 

State reason(s) for protest of assessed value and/or the tentative taxable value and/or classification and/or qualified agricultural property exemption. 

a 

or 

Top 

DRL no JRE 

/) 

CERTIFICATION _~/ J 

7/7] 

Sianature 

Lfu Java (p0)s2d-qu 

Ad 21), Dun A 

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] 

Form 618, Page 2 

FOR BOARD OF REVIEW USE ONLY 

INSTRUCTIONS: Incorporate a copy of this form and the assigned number in the Board of Review minutes. 

[7 

ion Number 

Parcel Code 

PIO 

14-34-577-109 

1. ASSESSED VALUE 

Disposition by Board of Review. The Board of Review must state the reason for its action below. 

Denied 

O 

Assessed Value Changed From: 

25,600 

To: 

[ 

| 

/ 

Record of Vote - Board or three member comm 

of board 

5 

/ 

( UP 

1 no 

O no 

& 

Member: 

ves 

[J noZl_ 

flals 

Chairperson: 4 YES 

L 

Member: 

bY YES 

Initial 

Initials 

Reason for Board Action: 

GALLS 

amaemue nuts fost puveahy 

If you disagree with the decision of the Board of Review regarding tentative assessed value, you may appeal that decision by filing a petition with the Michigan Tax Tribunal at 

PO Box 30232, Lansing, MI 48909. Commercial Real, Industrial Real, Developmental Real, Commercial Personal, Industrial Personal and Utility Personal Property may be 

ppealed by May 31. Agricultural Real, Residential Real, Timber - Cutover Real, and Agricultural Personal Property may be appealed by July 31. The petition must be filed on 

Michigan Tax Tribunal form or a form approved by the Michigan Tax Tribunal. Michigan Tax Tribunal forms are available at www.michigan.gov/taxtrib. 

2. TENTATIVE TAXABLE VALUE 

Disposition by Board of Review. The Board of Review must state the reason for its action below. 

Rl 

Denied 

0 

Tentative Taxable Value Changed From: 

15,023 

To: 

/ 

(See attached L-4035A) 

Record of Vote - Board or three member committee of board. 

Chairperson: 

Kf, ves 

O wT 

Member: 

JX 

ves 

O 

nol 

CC Member: 

A 

ves 

O N% 

Initials 

ials 

Initials 

Reason for Board Action: 

UU Coa, Lneome Din 

fg Bove 

I” 

disagree with the decision of the Board of Review regarding tentative taxable value, you may appeal that decision by filing a petition with the Michigan Tax Tribunal at 

| 

x 30232, Lansing MI 48909. Commercial Real, Industrial Real, Developmental Real, Commercial Personal, Industrial Personal and Utility Personal Property may be 

lappealed by May 31. Agricultural Real, Residential Real, Timber - Cutover Real, and Agricultural Personal Property may be appealed by July 31. The petition must be filed on 

Michigan Tax Tribunal form or a form approved by the Michigan Tax Tribunal. Michigan Tax Tribunal forms are available at www.michigan.gov/taxtrib. 

3. CLASSIFICATION 

Disposition by Board of Review. The Board of Review must state the reason for its action below. 

O 

Denied 

O 

Classification Changed From: 

401 

To: 

Record of Vote - Board or three member committee of board. 

Chairperson: 

[] Yes 

[J] No—— 

Member: 

[] Yes 

[J] 

Initials 

Member: 

[] YES 

[J NO 

Initials 

Initials 

Reason for Board Action: 

f you disagree with the decision of the Board of Review regarding classification, you may appeal by sending Form 2167 to the State Tax Commission, PO Box 30471, 

Lansing MI 48909, by June 30. 

4. QUALIFIED AGRICULTURAL PROPERTY EXEMPTION 

Disposition by Board of Review. The Board of Review must state the reason for its action below. 

O 

Exemption Request Denied 

[ll 

Exemption percent modified from 

% To: 

% 

Record of Vote - Board or three member committee of board. 

Chairperson: 

[] ves 

[J 

No 

Member: 

[J ves 

[J 

no 

Member: 

[] YES 

[] NO 

Initials 

Initials 

Initials 

Reason for Board Action: 

If you disagree with the decision of the Board of Review regarding qualified agricultural property exemption, you may appeal that decision by filing a petition with the Michigan 

Tax Tribunal, PO Box 30232, Lansing MI 48909 by July 31. The petition must be filed on a Michigan Tax Tribunal form or a form approved by the Michigan Tax Tribunal. 

Michigan Tax Tribunal forms are available at www.michigan.gov/taxtrib. 

DJOURNMENT 

|” Late of Final Adjournment of Board of Review 

L 

iew Secrgtary 

Bigpature 

Date 

Vid Bde 

Yl Pe 26

parcel 

Number: 

14-34-577-109 

Jurisdiction: 

MT MORRIS CHARTER TOWNSHIP 

County: 

Genesee 

Printed 

on 

03/11/2026 

[Grantor 

Grantee 

sale 

sale 

Inst. 

|Terms 

of sale 

Liber 

verified 

| Prent. | 

| 

Price 

Date 

Type 

| 

& Page 

[By 

| Trans. 

[CARACCT, MARJORIE M 

 |MATHIS, MICHELLE 

[ 

7,500| 06/20/2014 (wD 

|21-noT USED/OTHER 

|20140709005362 [DEED 

| 

100] 

[SPARKS, 

ELGEN 

M 

 |CARACCI, MARJORIE 

M 

= +000} "01/13/2014 

[QC 

|21-NOT USED/OTHER 

 |20140113000166|D! 

oo 

1100.00 

I 

I ed 

(SPARKS, 

DINE 

J ESTAT SPARKS, 

ELGEN 

M 

~1109/13/2004 [QC 

|08-ESTATE 

95102 

|DEED 

| 100.00] 

I 

TT 

- 

h 

© 

710,000] 03/23/1990 

wD ~~ 

|03-ARM'S LENGTH 

~~ |.c¢ 

[peep 

| 

| 

i 

SE 

— 

foe 

Mi bi 

niin 

I, inline inl 

SN 

iui 

=~ 

<SS5 ii iN 

_ 

[Property Address 

ass: 

RESIDENTIAL-IMPRO |zoning: 

R-3 

S [Building permit(s) 

Date 

Number 

[status 

|3065 ROANOKE ST 

|schooT: WESTWOOD HEIGHTS SCH DIST 

| 

TT 

7 

| 

~~ 

[P.R.E. 100% 06/30/2014 

| 

i 

si 

| 

- 

(owner s Name/Address 

MAP 

#: 

34 

— 

— 

[WATHIS, MICHELLE 

i 

i 

13065 ROANOKE ST 

| 

~ 

2026) Est. TCV" 51, 231] 

| 

| 

I 

1 

|FLINT, 

MI 48504 

[x 

Improved 

| 

[vacant 

Land Value Estimates for Land Table 2121. 2121 RES WWH 

! 

| 

} public oo 

ST 

CL 

BD I 

*_ 

Factors 

* 

Improvements 

Description 

Frontage 

Depth 

Front 

Depth 

Rate %Adj. 

Reason 

value 

aad 

— 

2121 

RES wwH 120.00 

99.00 1.0000 0.9950 

7100 

836 

lo 

Dirt Roa 

120 Actual 

Front Feet, 

0.27 Total Acres 

Total 

Est. 

Land value 

= 

836 

[Taxpayer's Name/Address 

X Crags! Rum 

DE 

| 

% 

foes ie 

Land Improvement Cost Estimates 

ST 

I 

FLINT, 

MI 48504 

[7 

lsidewalk 

Description 

Rate 

Size 

% Good 

cash value 

| 

’ 

| 

[Sidewa 

D/W/P: 

Brick on Sand 

15.65 

160 

60 

1,502 

| 

X (water 

shed: 

Metal 

prefabrication 

15.14 

80 

60 

727 

| 

» 

Co 

EE 

| 

X|Sewer 

Total 

Estimated Land Improvements True Cash value 

= 

2,229 

| 

Tax Description 

X 

[Electric 

TOTS 

196 197 & 198 WASHINGTON PARK SUB 

x 

|Gas 

r re 

ee ee 

{ 

74) 

curb 

| 

| 

Ts 

— 

| 

X 

|street Lights 

i 

|Comments/In 

uences 

~ 

oo 

_ 

X 

|standard utilities 

6/8/15 

INSPECTED PROPERTY, 

SPOKE WITH 

| 

underground utils. 

MICHELLE MATHIS. 

DB 

= 

| 

6-23-15 RECEIVED INFO SHEET BACK. 

LAS 

| 

Topography of 

16-15-22 INSPECTED PROPERTY, 

HSE 

IS 

A 

1 

L 

a 

| 

|ST/SLAB 

IN GOOD COND-BLOCK, 

NEWER ROOF, 

[X [Level 

i 

MOSTLY NEWER WINDOWS, 

OLDER WOOD SIDING-I 

| 

|Rolling 

. 

{Low 

| 

[High 

[Landscaped 

| 

{swamp 

|wooded 

{Pond 

{waterfront 

|Ravine 

\wetland 

— 

SE 

ES 

— 

a 

Year 

| 

Land] 

Building] 

Assessed 

Board of| 

Tribunal/| 

 Taxable| 

| 

| 

value 

| 

value 

| 

value 

| 

Review 

| 

other 

| 

value 

| 

I 

I 

1 

| 

| 

{Who 

when 

what 

[2026 

| 

400] 

25,600] 

[15,023] 

id 

ips 

at 

! 

TT 

EE 

| 

DB 

06/15/2022 

INSPECTED 

[2025 

500] 

23,200 

| 

DB 

06/08/2015 

INSPECTED 

[2024 

| 

400 

20,700] 

|2023 

I~ 

200 

) 

~16,900| 

B 

1 

| 

13,515¢!

Residential 

Building 

1 of 

1 

Parcel 

Number: 

14-34-577-109 

Printed on 

03/11/2026 

Bui Iding Type 

73) Roof (cont.) 

(11) Heating/Cooling 

(15) Built-ins 

(15) 

Fireplaces 

Building Style: 

Trim & Decoration 

1 ST RANCH 

[Ex [x]ord 

| 

[prin 

Yr Built 

[Remodeled 

1948 

0 

Size 

of Closets 

tg (x lor 

Small] 

condition: 

Good 

Doors 

| 

[Seid] 

x H.C. 

Room List 

Basement 

(5) 

Floors 

Radiant (in-floor) 

Electric: wall—Heat 

Space Heater 

wall/Floor Furnace 

Forced Heat & Cool 

Heat Pump 

No Heating/Cooling 

51st Floor 

2nd Floor 

2 (Bedrooms 

Kitchen: 

vinyl 

other: Carpeted 

other: 

Tile 

Central Air 

wood Furnace 

(12) Electric 

(1) 

Exterior 

(6) ceilings 

100] 

Amps Service 

1jvented Hood 

T|Intercom” 

Jacuzzi Tub 

Jacuzzi 

repl.Tub 

oven 

Microwave 

Standard Range 

self Clean Range 

Sauna 

Trash Compactor 

Central Vacuum 

Security System 

X 

[Single Family 

Eavestrough 

X 

[Gas 

[33] 

Elec. | IfAppliance Allow. 

Interior 

I Story 

Mobile Home 

X|Insulation 

wood 

coal 

Steam 

Cook Top 

Interior 

2 Story 

Town Home 

12|Front overhang 

Forced Air w/o bucts 

Dishwasher 

2nd/same Stack 

puplex 

12}other overhang 

X 

|Forced Air w/ Ducts 

Garbage Disposal 

Two Sided 

A-Frame 

(4) Interior 

Forced Hot Water 

Bath Heater 

Exterior 

1 Story 

X [Wood Frame 

X [Drywall 

Plaster 

Electric Baseboard 

Hot Tub 

xeon iid 

paneled 

wood T&G 

Elec. 

ceil. 

Radiant 

unvented Hood 

prefab 

2 story 

Heat_Circulator 

Raised Hearth 

wood Stove 

Direct-vented Ga 

(16) Porches/Decks 

(17) Garage 

ArealType 

Class: 

D +10 

effec. 

Age: 

45 

Floor Area: 

1152 

30jccP 

(I Story) 

Total 

Base New: 

145,959 

Total 

Depr Cost: 

80,276 

Estimated T.C.V.: 

48,166 

Year Built: 

Car Capracity: 

Class: 

Exterior: 

Brick ven.: 

Stone Ven.: 

Common Wall: 

Foundation: 

Finished 

7: 

Alito. 

Mech. 

Area: 

% Good: 

Storage Area: 

No Conc. 

Floor: 

Doors’ 

Doors: 

E.C.F. 

Bsmnt 

Garage: 

X 0.600 

carport Area: 

Roof: 

wood/ShingTe 

X 

[Aluminum/vinyl 

Brick 

X [Drywall 

No./qual. 

of Fixtures 

(7) 

Excavation 

X 

{Insulation 

Basement: 

0 S.F. 

(2) windows 

Crawl: 

0 S.F. 

Slab: 

1152 S.F. 

Many 

X 

{Ave. 

X 

Large 

Ave. 

Height to Joists: 

[EX- 

[x ord. 

| 

[Min 

No. 

of Elec. outlets 

[Many 

[ 

x Jave. 

| 

[Few 

(13) 

Plumbing 

0.0 

Few 

small 

(8) 

Basement 

wood Sash 

Metal 

Sash 

X 

vinyl 

sash 

X 

{poubie Hung 

Horiz. 

slide 

Casement 

Conc. 

Block 

poured Conc. 

Stone 

Treated Wood 

Concrete Floor 

(9) 

Basement Finish 

1|3 Fixture Bath 

2 Fixture Bath 

softner, 

Auto 

softner, 

Manual 

Solar Water Heat 

No Plumbing 

Extra Toilet 

Extra Sink 

Separate Shower 

[oy 

1livent 

Fan 

Average Fixture(s) 

ceramic Tile Floor 

Ceramic Tile wains 

Ceramic Tub Alcove 

(14) water/Sewer 

1 

1 

X 

[Double Glass 

Recreation 

SF 

Patio Doors 

Living 

SF 

storms 

& Screens 

walkout Doors 

(B) 

F 

No Floor 

SF 

(3) 

Roo 

0walkout Doors 

(A) 

GabTe 

Gambrel 

X 

[Hip 

mansard| 

(10) 

Floor support 

Flat 

shed 

Joists: 

unsupported Len: 

X 

|ashphalt shingle 

cnts. Sup: 

Chimney: 

Brick 

PubTic Water 

public sewer 

water well 

1000 Gal. 

Septic 

2000 Gal. 

Septic 

Lump Sum Items: 

Cost Est. 

for Res. 

Bldg: 

I 

Single Family 

1 ST RANCH 

(11) Heating system: 

Forced Air w/ Ducts 

Ground Area = 1152 SF 

Floor Area 

= 1152 

pPhy/Ab.Phy/Func/Econ/Comb. 

% Good=! 55/100/100/100/55 

Building Areas 

Cls 

bp 

10° 

BIt 1948 

«%% Information herein deemed reliable but not guaranteed*** 

Stories 

Exterior 

Foundation 

size 

Cost New 

Depr. 

Cost 

1 story 

siding 

slab 

1,152 

] 

Total 

139,490 

76,718 

other Additions/Adjustments 

Plumbing 

Ceramic Tile Floor 

1 

942: 

518 

vent Fan 

1 

170 

93 

Porches 

ccp 

(1 story) 

30 

914 

503 

Water/Sewer 

public water 

1 

1,187 

653 

Public Sewer 

1 

1,187 

653 

Built-Ins 

Appliance Allow. 

1 

1,655 

910 

vented Hood 

1 

414 

228 

Totals: 

145,959 

80,276 

Notes: 

BLOCK HSE 

ECF (NEIGHBORHOOD 2121) 

0.600 

=> TCV: 

48,166 

_— 

— 

pry

printed 

on 

03/11/2026 

parcel 

Number: 

14-34-577-109 

Residential Building 1 of 

1 

- 

— 

. 

em 

— 

. 

_10.0°_ 

. 

. 

SHED 

o 

{| 80.0sf 

WMM 

5H 

240 

10.0 

1STY SLAB 

= 

1152.0 sf 

I= 

BLOCK HSE 

HIP 

BRICK PAVERS 

= 

160.0 sf 

© 

<= 

ELEC 

50 

°o 

[<=] 

GRAVEL DRIVE 

cep | 

30.0 sf 

«s+ Information herein deemed reliable but not guaranteed*** 

— 

“=~ 

: 

~

03/10/2026" 

valuation 

10:15 AM 

Report 

AssessmentRoll Roll: 

MT 

MORRIS TWP 2026 

14-34-577-109 

Property Class: 

401 

Mngt 

34 

2026 

Est. T.C.V. 

MT MORRIS CHARTER TOWNSHIP 

MATHIS, 

MICHELLE 

3065 ROANCKE 

ST 

FLINT, 

MI 48504 

|. 

tand value Estimates for Land Table 2121.2121 RES WWH 

* Factors 

* 

pescription 

Frontage 

Depth 

Front 

Depth 

Rate %Adj. 

Reason 

value 

2121 RES WwH 120.00 

99.00 1.0000 0.9950 

7 

100 

836 

120 Actual 

Front Feet, 

0.27 Total Acres 

Total 

Est. 

Land value 

= 

836 

Land Improvement Cost Estimates 

Description 

Rate 

size % Good 

cash value 

p/w/P: 

Brick on Sand 

15.65 

160 

60 

1,502 

shed: Metal Prefabrication 

15.14 

80 

60 

727 

Total 

Estimated Land Improvements True Cash value 

= 

2,229 

cost Est. 

for Res. 

Bldg: 

1 

&ingle Family 

1 ST RANCH 

(11) Heating System: 

Forced Air w/ Ducts 

Ground Area 

= 1152 

SF 

Floor Area = 1152 

SF. 

phy/Ab. Phy/Func/Econ/Comb. 

% Good=55/100/100/100/55 

Building Areas 

cls 

bp 10 

BIt 1948 

Stories 

Exterior 

Foundation 

Size 

Cost New 

Depr. 

Cost 

1 story 

siding 

slab 

1,152 

Total: 

139,490 

76,718 

other Additions/Adjustments 

Plumbing 

ceramic Tile Floor 

1 

942 

518 

Fr Fan 

1 

170 

93 

Porches 

Cccp 

(1 Story) 

30 

914 

503 

- 

Water/Sewer 

Public water 

1 

1,187 

653 

Public Sewer 

1 

1,187 

653 

Built-Ins 

Appliance Allow. 

1 

1,655 

910 

Vented Hood 

1 

414 

228 

Totals: 

145,959 

80,276 

Notes: 

BLOCK HSE 

ECF (NEIGHBORHOOD 2121) 0.600 => TCV: 

48,166 

2026 

Est. T.C.V. 

14-34-577-109 

= 

51,231 

Est. TCV/Total 

Floor Area 

= 44.47 

2025 Assessed 

MBOR 

S.E.V. 

Base for 

Cap 

IRM 

23,200 

23,200 

23,200 

14,629 

2.70 

2026 

New 

Eq. Adjustment 

LOSS 

Additions 

Tax Adjustment 

Losses 

0 

2,400 

0 

0 

394 

0 

2026 Assessed 

MBOR 

S.E.V. 

capped 

 ->Taxable<- 

PRE/MBT 

25,600 

25,600 

25,600 

15,023 

15,023 

15,023

2026 

updated 12-03-25 

BOARD OF REVIEW 

POVERTY APPLICATION 

MT MORRIS TOWNSHIP 

5447 BICENTENNIAL DR 

MT MORRIS, MI 48458 

810-785-1054 

POVERTY APP 2025. DOC 

MAILED: 

N J 0 

f 

APPOINTMENT gio Marois, 

DATE: 

_/ha. 

/ 

TIME: 

Zo 

Jie 

PARCEL NO. 14- 34 = 512 =|07 

name: Mechelle 

CLASS: 

40) 

SD: 

A510 

Mats 

ADDRESS: 3&5 Roanoke St 

CITY: Fant, WT ARBss04 

810-8146! 

wxEER 

EFF Poverty exemption application must be filed YEARLY with the March, July, or 

December Board of Review in order to be considered for this exemption. 

The applicant must appear in person before the Board of Review. The applicant must fill out 

Form 5737 Application and Affirmation for MCL 211.7u Poverty Exemption in its entirety 

which is Attached. EXCEPTION: If ill health prevents applicant from coming to the Board of 

Review in person, an application will be mailed upon request. This application may be returned 

by mail along with all required documentation as listed below. 

Applicants MUST BE OWNERS of the property, RESIDE THEREIN, and provide COMPLETE 

COPIES of all the following documents for ALL: PERSONS RESIDING IN THE 

HOUSEHOLD before the day prior to the last day of Board of Review. 

> 

B 

Cc 

D 

E. 

F. 

G 

H 

I 

J 

2302S 

Copies of 202% Federal and State Income Tax returns with W-2"s, 1099’s and all other 

supporting wage statements 

v4 he EY 

2025 Michigan Homestead Property Tax Credit Form MI- 1040- CR. 

—D oni 

2025 Home Heating Credit Claim Form. — 

2025 End of year Social Security Statement. xX 

2025 End of year Pension Statement. 

2025 Copy of Monthly VA benefit check. 

2025 Statement of Unemployment benefits received. 

. 

2025 Bank or Credit Union statement reflecting interest earned. 

— £. 

2025 Statement of Income received from Trust Funds. 

2025 Statement reflecting Stock dividends earned. 

pusT- 

terest 

y ETI 

smi] 

- 

Feo 

- 

2025 Statement of benefits from any Federal or State Aid Programs, such as Be nedits 

ADC, GA, SSI, etc... FOR ALL MEMBERS OF HOUSEHOLD. 

Cs 

Failure to comply with the above will result in a denial. 

Page 

1 

ALL INFORMATION DISCLOSED ON A POVERTY EXEMPTION 

APPLICATION WILL REMAIN STRICTLY CONFIDENTIAL 

of 6 

MT MORRIS TOWNSHIP POVERTY APPLICATION

2026 

updated 12-03-25 

POVERTY APP 2025. DOC 

Applicants may be required to produce a valid driver’s license or other form of identification, 

and produce a deed, land contract, or other evidence of ownership of the property for which an 

exemption is being requested. 

The Board of Review will consider income according to Federal Poverty income Standards and 

revenue and non-revenue producing assets. 

A successful applicant may be subject to personal investigation by the Township. This would be 

done to verify information submitted or statements made to the Board of Review in regard to 

their poverty exemption claim. 

The following are the federal poverty income standards as of 12-31-25 for use in setting poverty 

exemption guidelines for 2026 assessments. Please see STC Bulletin No. 15 of 2025 for 

additional information regarding use of these standards. 

Poverty 

Size of Family Unit 

Threshold 

$15,650 

$21,150 

$26,650 

$32,150 

$37,650 

$43,150 

$48,650 

8 

$54,150 

For each additional person, add 

$5,500 

NON 

BW N= 

IMPORTANT NOTE: PA 390 of 1994 states the poverty exemption guidelines established by 

the governing body of the local assessing unit SHALL also include an asset level test. 

ALL INFORMATION DISCLOSED ON A POVERTY EXEMPTION 

APPLICATION WILL REMAIN STRICTLY CONFIDENTIAL 

Page 2 of 6 

MT MORRIS TOWNSHIP POVERTY APPLICATION

| 

2026 

updated 12-03-25 

POVERTY APP 2025. DOC 

Is there any further information that you desire to add? 

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Witness Signature 

Witness Signature 

FOR BOARD OF REVIEW USE ONLY 

Disposition by the Board of Review 

X Denied 

Date: 3° 

- doe 

Assessed Value Reduce from $ 

Board of Review Notes: 

ALL INFORMATION DISCLOSED ON A POVERTY EXEMPTION 

APPLICATION WILL REMAIN STRICTLY CONFIDENTIAL 

Page 5 of 6 

MT MORRIS TOWNSHIP POVERTY APPLICATION

2026 

updated 12-03-25 

POVERTY APP 2025. DOC 

ALL INFORMATION DISCLOSED ON A POVERTY EXEMPTION 

APPLICATION WILL REMAIN STRICTLY CONFIDENTIAL 

Page 6 of 6 

MT MORRIS TOWNSHIP POVERTY APPLICATION

2026 

updated 12-03-25 

POVERTY APP 2025. DOC 

MEET THE FOLLOWING ASSET TEST: 

The following assets shall not be considered when applying an asset test to determine 

qualification for tax exemption. 

a.) The value of the applicant’s primary residence subject to the exemption. 

b.) The value of all furniture, clothing, and other ordinary household items. 

¢.) The first $20,000 (twenty thousand) dollars of the market value (established by Kelly 

Blue Book) of a motor vehicle. 

The value of all additional assets which the Board of Review shall consider include, but 

are not limited to: 

real estate other than principal residence, motor vehicles, recreational 

vehicles and equipment, certificates of deposits, savings accounts, checking accounts, 

stocks, bonds, life insurance, Retirement funds, TV’s, computers, jewelry, other 

electronics, trailers, boats, other outdoor equipment, ATVs, dirt bikes, etc, and the value 

shall not be reduced by any indebtedness owed on such asset, or indebtedness otherwise 

owed by the applicant’s. 

Assets shall not exceed $10,000 (ten thousand) dollars for an individual applicant and/or 

$20,000 (twenty thousand) dollars per household. 

All asset information, as requested in the application for Property Tax Exemption must be 

completed in total. The Board of Review may request additional information and 

verification of assets if they determine it to be necessary and may reject any application if 

assets are not properly identified. 

Considered as Assets: 

+ A second home (Additional Property other than the Principal Residence), land, and 

vehicles 

« Recreational vehicles such as campers, motor-homes, boats and ATV's 

+ Buildings other than the residence 

« Jewelry, antiques, artworks 

+ Equipment, other personal property of value 

« Bank accounts (over a specified amount), stocks 

+ Money received from the sale of property, such as, stocks, bonds, a house or car (unless 

a person is in the specific business of selling such property) 

« Withdrawals of bank deposits and borrowed money 

« Gifts, loans, lump-sum inheritances and one-time insurance payments 

+ Food or housing received in lieu of wages and the value of food and fuel produced and 

consumed on farms 

+ Federal non-cash benefits programs such as Medicare, Medicaid, food stamps and 

school lunches 

ALL INFORMATION DISCLOSED ON A POVERTY EXEMPTION 

APPLICATION WILL REMAIN STRICTLY CONFIDENTIAL 

Page 3 of 6 

MT MORRIS TOWNSHIP POVERTY APPLICATION

2026 

updated 12-03-25 

POVERTY APP 2025. DOC 

INCOME IS DEFINED AS FOLLOWS: 

1. 

Money wages and salaries (gross) before any deductions. 

2 

Net receipts from non-farm self-employment. These are receipts from a person’s own 

business, professional enterprise, or partnership, after deductions for business expenses. 

3. 

Net receipts from farm self-employment. These are receipts from a farm which one 

operates as an owner, renter, or sharecropper, after deductions from farm operating 

expenses. 

4. 

Regular payments from social security, railroad retirement, unemployment compensation, 

strike benefits from union funds, worker’s compensation, veterans’ payments, public 

assistance (including Aid to Families with Dependent Children, Supplemental Security 

Income, Emergency Assistance money payments, and non-Federally-funded General 

Assistance or General Relief money payments.) 

5, 

Alimony, child support, and military family allotments or other regular support from an 

absent family member or someone not living in the household. 

6. 

Private pensions, government employee pensions (including military retirement pay) and 

regular insurance or annuity payments. 

7 

College or university scholarships, grants, fellowships, and assistantships. 

8. 

Dividends, interest, net rental income, net royalties, periodic receipts from estates or trust 

and net gambling or lottery winnings. 

INCOME DOES NOT INCLUDE THE FOLLOWING: 

1. 

Money received from sale of property such as stocks, bonds, a house, or a car unless a 

person is in the business of selling such property. 

2. 

Withdrawals of bank deposits and borrowed money. 

3. 

Tax refunds, gifts, loans, lump-sum inheritances, one-time insurance payments. 

4. 

Food or housing received in lieu of wages and the value of food and fuel produced and 

consumed on farms. 

5. 

Federal non-cash benefit programs such as Medicare, Medicaid, food stamps, and school 

lunches. 

ALL INFORMATION DISCLOSED ON A POVERTY EXEMPTION 

APPLICATION WILL REMAIN STRICTLY CONFIDENTIAL 

Page 4 of 6 

MT MORRIS TOWNSHIP POVERTY APPLICATION

| 

Michigan Department of Treasury 

5737 (Rev. 10-25), Page 1 of 4 

RB E 

- 

Application and Affirmation for MCL 211.7u Poverty Exempti 

CE IV =D 

This form is issued under the authority of the General Property Tax Act, Public Act 206 of 1893, MCL 211.7u. 

MCL 211.7u of the General Property Tax Act, Public Act 206 of 1893, provides a property tax exériyftich fop 

principal 

residence of persons who, by reason of poverty, are unable to contribute toward the public charges. This application is 

to be used to apply for the exemption and must be filed with the Board of Review where the\ Srgpaty i RR This 

application may be submitted to the city or township where the property is ocaadilegarmemencs 

RGATY-1 but 

the 

BEER FON Hip 

To be considered complete, this application must: 1) be completed in its entirety, 2) include information regarding all 

members residing within the household, and 3) include all required documentation as listed within the application. Please 

write legibly and attach additional pages as necessary. 

PART 1: PERSONAL INFORMATION — Petitioner must list all required personal information. 

Petitioner's Name 

r 

2 A 

Daytime Phage 

Number 

Aiche (le 1Yptbes 

F039 EF lo) 

1] 

Age of Petitioper, 

Marital Stat, 

) 

Age of Spouse 

~ 

Number of Legal Dependents 

J7 

ingle 

Property 

Address of Principal Residence 

7 

City 

2 

State 

Zp 

Code 

2306S Ronnpke Shrent 

Flint 

ML 48504 

PART 2: REAL ESTATE INFORMATION 

before the day prior to the last day of the board of review. Poverty Exemptions may be hear 

during its March, July, and December sessions. 

List the real estate information related to your principal residence. Be prepared to provide a deed, land contract or other 

evidence of ownership of the property at the Board of Review meeting. 

Property Parcel Identification Number 

Name of Mortgage Company 

[4-3 

EHF - 109 

N/A 

Unpaid Balance Owed on Principal Residence 

Monthly Payment 

Length of Time at this Residence 

NA 

NA 

1S Years 

Property Description 

Sine 

Family Howe. ster Flat 

| 

PART 3: AFFIRMATION OF OWNERSHIP, OCCUPANCY, AND INCOME STATUS (Check all boxes that apply.) 

| 

| own the property in which the exemption is being claimed. 

The property in which the exemption is being claimed is used as my homestead. Homestead is generally defined 

as any dwelling with its land and buildings where a family makes its home. 

PART 4: ADDITIONAL PROPERTY INFORMATION 

List information related to any other property owned by you or any member residing in the household. 

P 

: 

Amount of Income Earned from other Propert; 

0 Check if you own, or are buying, other property. If checked, complete the 

oH 

PER 

information below. 

Property Address 

City 

State 

ZIP Code 

1 

Name of Owner(s) 

Assessed Value 

Date of Last Taxes Paid 

Amount of Taxes Paid 

Property Address 

City 

State 

ZIP Code 

2 

Name of Owner(s) 

Assessed Value 

Date of Last Taxes Paid 

Amount of Taxes Paid 

Continue on Page 2

5737, Page 2 of 4 

PART 5: EMPLOYMENT INFORMATION — List your current employment information. 

Name of Employer 

N 

/ I 

if 

Address of Employer 

City 

State 

ZIP Code 

Contact Person 

Employer Telephone Number 

PART 6: INCOME SOURCES 

List all income sources, including but not limited to: salaries, Social Security, rents, pensions, IRAs (individual 

retirement accounts), unemployment compensation, disability, government pensions, worker's compensation, 

dividends, claims and judgments from lawsuits, alimony, child support, friend or family contribution, reverse mortgage, 

or any other source of income, for all persons residing at the property. 

Monthly or Annual Income 

Source of Income 

(indicate which) 

Social Sgtwrdy Snoome 

IRE 

Cy poelw, 

The. 

B4l80 © 

PART 7: CHECKING, SAVINGS AND INVESTMENT INFORMATION 

List any and all savings owned by all household members, including but not limited to: checking accounts, savings 

accounts, postal savings, credit union shares, certificates of deposit, cash, stocks, bonds, or similar investments, for all 

persons residing at the property. 

Name of Financial Institution 

Amount 

Current 

Value of 

or Investments 

on Deposit 

Interest Rate 

Name on Account 

Investment 

nti 

| 

50% 

Tun 

|ofdete Mois | wpa 

7 

Tn Kegan iC 

o 

| nm 

| Bdenickledun Je | nse 

PART 8: LIFE INSURANCE — List all policies held by all household members. 

Amouiit of 

Monthly 

Policy Paid in 

Relationship to 

Name of Insured 

Policy 

Payments 

Full 

Name of Beneficiary 

Insured 

as 

PART 9: MOTOR VEHICLE INFORMATION 

All motor vehicles (including motorcycles, motor homes, camper trailers, etc.) held or owned by any person residing 

within the household must be listed. 

Make 

Year 

Monthly Payment 

Balance Owed 

Koa 

Rie 

20! 

_ 

~e- 

= 

| Subaru Impltzr- 

 Jo2o 

Bp 00 

#19000. oO 

a 

7 

Continue on Page 3

[ 

«0: HOUSEHOLD OCCUPANTS — List all persons living in the household. 

Relationship 

$ Contribution to 

First and Last Name 

Age 

to Applicant 

| Place of Employment | Family Income 

Wlihidle (Yethis 

He 

| Self 

lor.20 

Kodenck 

2 

Nee beso 

Golo 

TCT 

| 

4 go 2 

FAR 

PART 11: PERSONAL DEBT 

— 

List all personal debt for all household members. 

Creditor 

5g 

Purpose of Debt 

Ba 

Original Balance [Monthly Payment] 

Balance Owed 

Tran lems 

esol TRrsomal Loan | ©2033 poy wo 

|% 3500 

et Tne 

|Buy 

ni Ret lafer hors” Rigen. © lo ld” | 593.2 

Fr em Ine. 

By 

i Nass 

clojaeas 

® Foo 

| £17. 

|& 79> 

AL pn Tne 

Buy eau 

le 2) 525] ¥ 540, co 

|#$g.®@ 

Kay .@ 

MinIne 

Nel ops’ | 228. °° | 823.50 

K (68.77 

AF Tne. 

|umsscned 

| Wao Rio 

[4 1.2 

| 673, 

ME 

Tne. 

|ungetueed 

13/0035 Rb 250.00 

8 2750 3151. 

Wiss 

i sm Bek 

Caedit Car. 

1)2033 $500 2 

|§ 55.00 

8 ® 

PART 12: MONTHLY EXPENSE INFORMATION 

The amount of monthly expenses related to the principal residence for each category must be listed. Indicate N/A as 

necessary. 

225% 

[TF 200.90 

[8580.90 

 |laedgrd-¢ll 

Cable 

— 

Fa 

| $5.02 

Cotingyy =D. 

ey 7 ve 

= Lg Ps) 

Daycare Be— 

EEN 

repaif, etc.) 

Other (type and amount) 

Other (type and amount) 

Other (type and amount) 

Other (type and amount) 

Other (type and amount) 

Other (type and amount) 

Continue and sign on Page 4

5737, Page 4 of 4 

NOTICE: Per MCL 211.7u(2)(b), federal and state income tax returns for all persons residing in the principal residence, 

including any property tax credit returns, filed in the immediately preceding year or in the current year must be submitted 

vith this application. Federal and state income tax returns are not required for a person residing in the principal residence 

f that person was not required to file a federal or state income tax return in the tax year in which the exemption under this 

section is claimed or in the immediately preceding tax year. 

PART 13: POLICY AND GUIDELINES ACKNOWLEDGMENT 

The governing body of the local assessing unit shall determine and make available to the public the policy and 

guidelines used for the granting of exemptions under MCL 211.7u. In order to be eligible for the exemption, the 

applicant must meet the federal poverty guidelines published in the prior calendar year in the Federal Register by the 

United States Department of Health and Human Services under its authority to revise the poverty line under 42 USC 

9902, or alternative guidelines adopted by the governing body of the local assessing unit so long as the alternative 

guidelines do not provide income eligibility requirements less than the federal guidelines. The policy and guidelines 

must include, but are not limited to, the specific income and asset levels of the claimant and total household income 

and assets. The combined assets of all persons must not exceed the limits set forth in the guidelines adopted by the 

local assessing unit. 

The applicant has reviewed the applicable policy and guidelines adopted by the city or township, including the 

specific income and asset levels of the claimant and total household income and assets. 

PART 14: LEGAL DESIGNEE INFORMATION (Complete if applicable.) 

oe Mckelle Moths 

Crt 

Tint 

MA d8a04 

2005 Keunoke Steet 

PART 15: CERTIFICATION 

| hereby certify to the best of my knowledge that the information provided in this form is complete, accurate and 

| am 

eligible for the exemption from property taxes pursuant to Michigan Cprpiieg baw, Section 211.7u. 

Signature 

en 

Date 

Printed Na 

nl holle IN oS 

7 5/472) 

(Bha/>03¢ 

XX 

77 

7 

a4 

This application shall be filed after January 1, but before the day prior to the last day of the local unit's December 

Board of Review. 

ie 

Decision of the March Board of Review may be appealed by petition to the Michigan Tax Tribunal by July 31 of 

the current year. A July or December Board of Review decision may be appealed to the Michigan Tax Tribunal by 

petition within 30 days of decision. A copy of the Board of Review decision must be included with the petition. 

Michigan Tax Tribunal 

PO Box 30232 

Lansing MI 48909 

Phone: 517-335-9760 

Email: taxtrib@michigan.gov

' 

Michigan Department of Treasury 

4988 (05-12) 

Roverty Exemption Affidavit 

's form Is Issued under authority of Public Act 206 of 1893; MCL 211.7u. 

INSTRUCTIONS: When completed, this document must accompany a taxpayer's Application for Poverty Exemption filed 

with the supervisor or the board of review of the local unit where the property is located. MCL 211.7u provides far a whole 

or partial property tax exemption on the principal residence of an owner of the property by reason of poverty and the 

inability to contribute toward the public charges. MCL 211.7u(2)(b) requires proof-of eligibility for the exemption be provided 

to the board of review by supplying copies of federal and state income tax returns for all persons residing in the principal 

residence, including property tax credit returns, or by filing an affidavit for all persons residing in the residence who were not 

required to fij 

federal or state income 

ta 

rns for the current or preceding tax year. 

L 7 

N Mull, 

X 

, swear and affirm by my signature below that 

| 

reside/ 

in the princigdl réidence that is the subject of this Application for Poverty Exemption and that 

for the current tax year and the preceding tax year, 

| was not required to file a federal or state income 

tax return. 

Address of Principal Residence: 065" E pine ke SE 

Fiver, YW Ags02{ 

Yop 

: 

72D 

13/47 /203¢ 

7 

Sigpbtlre tt érson Making Affidavit 

/ ate

RESOLUTION FOR POVERTY GUIDELINES 

FOR 2026 TAXES # 2026-_°% 

WHEREAS, pursuant to P. A. 390 of 1994, which amended Section 7u of Act 206 of the 

Public Acts of 1893, as amended by Act 313 of the Public Acts of 1993, being Section 

211.7u of the Michigan Compiled Laws requires the governing body of the assessing unit 

to determine and make available to the public policy and guidelines for the granting of 

poverty exemptions under this section; therefore, be it. 

WHEREAS, pursuant to P. A. 390 of 1994, Mt. Morris Charter Township, Genesee 

County adopts the following guidelines for the board of review to implement. 

The 

guidelines shall include but are not limited to the specific income and asset levels of the 

claimant and all persons residing in the household, and any other owners listed on the 

deed: 

1.) Be an owner of and occupy as their principal residence the property for which 

the exemption is requested. 

2.) File a claim with the board of review, accompanied by federal and state 

income tax returns for all persons residing in the principal residence. 

3.) Produce a valid drivers’ license or other form of identification if requested. 

4.) Produce a deed, land contract, or other evidence of ownership of the property 

for which an exemption is requested. 

5.) Meet the federal poverty income standards 

as defined and determined 

annually by the United States Office of Management and Budget. 

Size of Family Unit 

Poverty Guidelines 

$15,650 

1 

2 

$21,150 

3 

$26,650 

4 

$32,150 

5 

$37,650 

6 

$43,150 

7 

$48,650 

8 

$54,150 

For each additional person 

~~ $5,500

6.) Meet the following Asset test in order to qualify for a poverty exemption. 

The following assets shall not be considered when applying an asset test to 

determine qualification for tax exemption. 

The 

value 

of the 

applicant's 

primary residence 

subject 

to 

the 

exemption. 

The value of all furniture, clothing, and other ordinary household 

items. 

The first $20,000 (twenty thousand) 

dollars 

of the market value 

(established by Kelly Blue Book) of a motor vehicle. 

The value of all additional assets which the Board of Review shall consider 

include, but are not limited to: 

real estate other than principal residence, 

motor vehicles, recreational vehicles and equipment, certificates of deposit, 

savings accounts, checking accounts, stocks, bonds, life insurance, retirement 

funds, TV’s, 

computers, jewelry, 

other electronics, 

trailers, 

boats, 

other 

outdoor equipment, ATV's, dirt bikes, etc, and the value shall not be reduced 

by any indebtedness owed on such asset, or indebtedness otherwise owed by 

the applicants. 

Assets shall not exceed $10,000 (ten thousand) dollars for an individual 

applicant and/or $20,000 (twenty thousand) dollars per household. 

Considered Assets: 

* 

A second home (Additional Property other than the Principal 

Residence), land, vehicles 

* Recreational vehicles such as campers, motor-homes, boats and 

ATV’s 

« Buildings other than the residence 

« Jewelry, antiques, artworks 

+ Equipment, other personal property of value 

* Bank accounts (over a specified amount), stocks 

* Money received from the sale of property, such as, stocks, bonds, 

a house or car (unless a person is in the specific business of selling 

such property) 

* Withdrawals of bank deposits and borrowed money 

* Gifts, loans, lump-sum inheritances and one-time insurance 

payments 

» Food or housing received in lieu of wages and the value of food 

- 

and fuel produced and 

consumed on farms

» Federal non-cash benefits programs such as Medicare, Medicaid, 

food stamps and school lunches 

All asset information, as requested in the application for Property Tax 

Exemption must be completed in total. The Board of Review may request 

‘additional information and verification of assets if they determine it to be 

necessary and may reject any application if assets are not properly identified. 

A successful applicant may be subject to personal investigation to verify the 

information submitted or statements made to the Board of Review in regard to 

their poverty exemption claim, 

. 

The foregoing resolution offered by Board Member 

A WEN 

and supported by Board Member 

Bax TER 

Upon roll call vote, the following voted “Aye:” “Nay:” 

The supervisor declared the resolution adopted. 

2 

I, 

DeWay 

Aller 

| the duly elected and acting Clerk of Mt. Morzis 

Charter Township, hereby certify that the foregoing resolution was adopted by the 

township board of said township 

at the regular meeting 

of said held 

on 

[EBA 

7 

, 2026, at which meeting a quorum was present by a 

roll call vote’of said members as hereinbefore set forth; that said resolution was 

ordered to take immediate effect. 

HAE 

Dewayn Allen 

Clerk

% 

Social Security Administration 

Benefit Verification Letter 

Date: March 5, 2026 

BNC# 

REF: DI 

SUT phen glob goggt fates ap 

so Mone os] J 1] 

RODERICK LAMONT CHATMAN JR 

3065 ROANOKE ST 

FLINT MI 48504-1708 

You asked us for information from your record. The information that you requested 

is shown below. If you want anyone else to have this information, you may send 

them this letter. 

Information About Supplemental Security Income Payments 

pogioning March 2026, the current Supplemental Security Income payment 

is 

$0.00. 

This payment amount may change from month to month if income or living 

situation changes. 

Supplemental Security Income Payments are paid the month they are due. 

{for Srample, Supplemental Security Income Payments for March are paid in 

arch. 

We found that you became disabled under our rules on April 9, 2018. 

Type of Supplemental Security Income Payment Information 

You are entitled to monthly payments as a disabled individual. 

Date of Birth Information 

The date of birth shown on our records is July 11, 1994. 

Suspect Social Security Fraud? 

Please visit http://oig.ssa.gov/r or call the Inspector General's Fraud Hotline at 

1-800-269-0271 (TTY 1-866-501-2101). 

See Next Page 

S08093W 

STATI CLIN DD »LAXO0ISTATHTOTO0x

26WG869E46751 

Page 2 of 2 

If You Have Questions 

Need more help? 

1. 

Visit www.ssa.gov for fast, simple and secure online service. 

9. 

Call us at 1-800-772-1213, wedkdays from 8:00 am to 7:00 pm. Ifyou are 

deaf or hard of hearing, call TTY 1-800-325-0778. Please mention this letter 

when you call. 

3. 

You may also call your local office at 1-877-748-9766. 

SOCIAL SECURITY 

2021 W. CARPENTER RD 

FLINT MI 48505 

Sacial Security Udministration

-, 

~ 

Be 

mma 

Notice of Cost-of-Living Adjustment (coLa) 

Hello MICHELLE R MATHIS 

Jour Social Security benefit will increase by 2.8% in January 2026. Next Year, receive your benefit information 

upto three weeks earlier by creating an online my Social Security account at www.ssa.gov/myaccount. You'can 

use this letter as proof of your benefit amount if you need to apply for food, rent, or energy assistance. You can 

also use it to apply for hank loans and for other business. Keep this letter with your important financial records 

or access this information anytime online by signing in to your personal my Social Security account, 

; 

[EW 

ar 

Monthly Amolint: 

* 

Fk snl 

i 

$1,601.00 

\ 

Monthly Amount 

-$0.00 

Medicare Prescription Dyug Plan (Part D) 

-$0,00 

We will notify you if the amount changes in 2026. If you did not elect withholding as of 

’ 

November 1, 2025, we show $0.00. 

us. federal tax withholding for non-citizens 

-$0.00 

Voluntary federal tax withholding 

-$0.00 

) 

i you did not elect voluntary tax withholding as of November 20, 2025, we show $0.00. 

| 

How Much You Will Get In 2026 (After Peductions) 

Monthly Amount 

Your monthly benefit in 2026 after deductions 

$1 601.00 

|. 

This monthly amount may Include deductions not listed above, 

’ 

BRS 

For more information about your COLA and other benefits-related topics such as 

Medicare, Ticket to Work, Reporting Wages, Earnings Limits, Other Pensions, 

and more, go to www. ssa.gov/cola or scan the QR code. 

If you would like a paper copy of any of this information, please contact us.

¥ 

t 

nine by signing into your pi 

Era 

‘Medicare Medical Insurance (Part B and Part 0) 

you did not have Medicare 5 s of November 20, 2025, ar if someone else pays your premium, 

we show §0.00. 

ersonial my Soelal Sevurity account, 

RN 

£0 Tf 

important financial records 

Medicare Prescription Drug Plan (Part D) 

We will notify you if the amount changes in 2026. If you did not elect withholding as of 

November 1, 2025, we show $0.00. 

U.S. federal tax withholding for non-citizens 

Voluntary federal tax withholding 

If you did not elect voluntary tax withholding as of November 20, 2025, we show $0.00. 

How Ruch You Will Get In 2026 (After Deductions) 

. 

. 

Monthly Amount 

Yr monthly benefit in 2026 after deductions 

] 

Ss monthly amount may include deductions not listed above. 

$1,601.00 

For more information about your COLA and other benefits-related topics such as 

Aedicare, Ticket to Work, Reporting Wages, Earnings Limits, Other Pensions, 

nd more, go to WiWw.ssa.gov/cola or'scan the QR code. 

you would like a paper copy of any of this information, please contact us. 

2d wore help? 

1. Visit www. ssa. gov for fast, simple, and secure online service, 

. 

1-800-772-1213, weekdays from 8:00 am. to 7:00 pm. If you are deaf or 

* Tard of se call TTY 1-800-325-0778. Please mention this letter when you call, 

3. You may also call your local office at 1-877-748-9766. 

SOCIAL SECURITY 

2021 W. CARPENTER RD 

FLINT, Ml 48505 

J 

BNC#: 25B1807E33495 

Overy»

3 

#n Department of Treasury (Rev. 04-25), Page 1 of 3 

Amended Return [I 

2u25 MICHIGAN Homestead Property Tax Credit Claim MI-1040CR 

Issued under authority of Public Act 281 of 1967, as amended. 

~Jype or print in blue or black ink. 

Attachment 05 

1. Filer’ 

“rst Name, 

ML | Last 

cchel [e. 

K 

[eck th > 

Ifa To Eo Spouse's First Name 

M.L 

Tost Name 

ey Address (Nj 

2,6 

1 

er, Street, P.O. Box). If using a P.O. Box, you must complete line 45. 

in 

\C 

« £ 

=k 

2. Filer's Full Social Security No. (Example: 123-45-6789) 

7 

| BN j IB £3 IN 789) 

i 

City or Tawn 

ink 

State 4 

ZIP/Postal Code 

Boo 

C auntry Code 

25 

4, School District Code (5 digits) 

a. 

5. Check the box(es) for which you or your spouse qualify (excluding depen 

Age 65 or older; or an unremarried spouse of a person 

who was 65 or older at the time of death. 

den 

ya] 

If you qualify for both, see instructions. 

Deaf, blind, hemiplegic, paraplegic, quadriplegic, or 

totally and permanently disabled. 

6.2025 FILING STATUS: 

Check one. 

b. 

Married filing jointly 

c. [| Married filing separately 

Single 

(Include Form 5049) 

c. | Part-Year Resident * 

7.2025 RESIDENCY STATUS: 

Check all that apply. 

a. BS) Resident 

b. | Nonresident 

FROM: 

TO: 

*If you checked box “c,” enter dates of Michigan residency in 2025, 

Enter dates as MM-DD-YYYY. 

FILER 

SPOUSE 

—_ 

— 2025 

-_— 

— 2025 

—_— 

— 2025 

— 

— 2025 

8. Homestead Status 

12. 

13. 

Check here if the taxable value of your homestead includes unoccupied farmland classified as agricultural by your local assessor. 

Homeowners: Enter the 2025 taxable value of your homestead (see instructions). If you did not 

check box 8 above and your taxable value [s greater than $165,400, STOP; you are not eligible. 

Farmers: ehter the taxable value of your homestead, including eligible unoccupied farmland 

Property taxes levied on your home for 2025 (see instructions) or amount from line 51, 56 and/or 57 

Renters: Enter rent you paid for 2025 from line 53 and/or 55 

Multiply ine 11 by 23% (0.23).....vuccviciiiccmmmmississsisincsssissimisssonmsiesssmissiisssssssssssssisssssssssssssseses 

Total. Add lines 10 and 12°.. 

TOTAL HOUSEHOLD RESOURCES. If filing a joint return, include income from both spouses. 

If married filing separately, you must include Form 5049. 

14. 

15. 

16. 

28. 

Wages, salaries, tips, sick, strike 

and SUB pay, etc. 

. 

All interest and dividend income 

(including nontaxable interest)...... 

Net business income (including net 

farm income), If negative, enter “0” 

Net royalty or rent income. 

If negative, enter “0”. ....cccoeveuvennnene 

Retirement, pension, annuity, and 

IRA benefits. 

Capital gains less capital losses 

(see INStructions}). u.weeceemsiiesssiens 

. 

Alimony and other taxable income 

Describe: 

21. 

14, 

00 

22. 

15, 

a0 

23. 

18, 

00 

24. 

17) 

Qo 

25, 

184 

00 

26. 

19) 

00 

27. 

20. 

00 

SUBTOTAL. Add lines 14 through 27 

+ 0000 2025 

25 

01 

27 

6 

I. 

9 

/ 4 & CO 

|g 

10. 

7 

7 g 

00 

11. 

00 

. 

12, 

D 

lwo 

79 8 

00 

Social Security, SSI, and/or 

— 

railroad retirement benefits... 

21. 

] 55 7 

100 

Child support and foster 

parent payments.......ccunnn 

22. 

[o[4] 

Unemployment 

compensation. ose. 

23. 

00 

Gifts received or expenses 

paid on your behalf............... 

24. 

00 

Other nontaxable income 

Describe: 

25. 

00 

Workers'/veterans’ disability 

compensation/pension benefits 

~~ 26. 

ao 

FIP and other MDHHS benefits 

(Do not include food assistance) 

27. 

00 

SUBTOTAL 

28. 

/5 2 a 

Qo 

Continue on page 2. This form cannot be 

processed if pages 2 and 3 are not completed and included.

[ 

‘. 

“a 

Even 

FE 

"2025 MI-1040CR, Page 2 of 3 

Flees FllSocl Sealy Humber rr 

1 

“Ve. 

Enter subtotal from INE 28.....cviiciiciniiisien 

snr seseinesesss assesses essssssssassnssssss sass sosnsnsassansan 

29. 

Z 55 t- 

00 

30. 

Other adjustments (see instructions). 

Describe: 

30. 

[&] 

31. 

Medical insurance/HMO premiums you paid for you and your family 

(SEE INSITUCHIONS) crvvrevssenerusnrersaserssssmessarmssssssesiusmssssssesrsssssesssssassssessssssrsass 

31. 

o 

ols 

32. 

Add IINES 30 BRA Buisness 

esis ier seers sesesssssasstessasnassenssesssstsssasss 

basa sestssssssessnarasssen 

32. 

00 

o 

33. 

TOTAL HOUSEHOLD RESOURCES. Subtract line 32 from line 29. 

77 

If more than $71,500, STOP; you are not eligible for this credit. 

.. 

33. 

yi 5 

00 

34, 

Multiply line 33 by 3.2% (0.032) or by the percent in Table 2 (see instructions). If negative, enter “0”. 

34. 

1 [4] 

00 

35. 

Subtract line 34 from line 13 and enter the amount here. If line 34 is greater than line 13, enter “0” 

2 = 

and STOP; you are not eligible for this Credit. ......couiecrcmnomeg ss msec 

35. 

7 

00 

PART 1: ALLOWABLE COMPUTATION Complete one of the sections below, either A, B, or C (see instructions). 

SECTION A: SENIOR CLAIMANTS (if you checked only box 5a) 

36. 

Enter amount from NE 35 cumini 

isssssssssssessssssrssssasssssissassss sass sassssssassasasan 

36. 

00 

37. 

Percentage from Table A (see instructions) that applies to the amount 

ON INE BB anisms 

sb sae 

nee 

37. 

% 

00 

38. 

Multiply line 36 by line 37. Enter amount here and on line 42 (maximum $1,900)... 

SECTION B: DISABLED CLAIMANTS (if you checked only box 5b, or both boxes 5a and 5b) 

39. 

Enter amount from line 35 here and on ling 42 (MAXIMUM $1,800) ...eveeorrssseessseseromomsoessesessee s.| 

FAE 

lwo 

SECTION c: ALL OTHER CLAIMANTS (if you did not check box 5a or 5b) 

40. 

Enter amount from INE 358. .....cuemiiininiiiniiiiiii 

is sss 

sss 

40. 

00 

41. 

Multiply amount on line 40 by 60% (0.60). Enter amount here and on line 42 (maximum $1,900)...... 

41. 

00 

PART 2: PROPERTY TAX CREDIT CALCULATION All filers must complete this section. 

42. 

Enter amount from line 38, 39 or 41, or from Worksheet 4 (see instructions) for FIP/MDHHS 

recipients 

43, 

Percentage from Table B (see instructions) that applies to the amount 

ON ING BB. 43. 

% 

44, 

PROPERTY TAX CREDIT. Multiply amount on line 42 by percentage on line 43. Enter amount here 

7. 

and if you file an MI-1040, carry this amount to MI-1040, line 26........cccciivniirnnennecinsnesmierse. 

44. 

7 8 

00 

00 

NOTE: Seniors who pay rent (including rent paid to adult care facilities): Complete 

Worksheet 5 in the MI-1040 book and enter amount from worksheet on line 44 (maximum 

$1,900). 

Continue on page 3. This form cannot be 

processed if pages 2 and 3 are not completed and included. 

+ 0000 2025 

25 

02 

27 

4

; 

A 

[ 

id 

Vt! 

R 

. 

“Michigan Départment of Treasury (Rev. 01-26), Page 1 of 

3 

2025 MICHIGAN Home Heating Credit Claim MI-1040CR-7 

Issued under authority of Public Act 281 of 1967, as amended. 

File (postmark) your claim by September 30, 2026. Type or print In blue bs black ink. 

Attachment 08 

Amended Return A 

1. 87 First 

ick lo 

fa 

Kod) Hs 

2. Filer’s Full Social Security No. (Example: 12346-6769) 

J 

[ita p47] 

Retum, Spouse's First Name 

MI. 

| 

LastName 

: 

: 

3. Spouse's Full Social Security No. (Example: 123-45-6789) 

2s 

(Numb 0 

Street, or 

0. pa SA 

: 

: 

City or Town 

State | ZIP/Postal Code | Country Code | 4, County Code (see Instructions) 

Fink 

 lmibg 

5. Homeowner/Renter Status 

 Pcpomecuner 

[1 Renter with utilities in rental cost 

[1 Renter with utiiies bitied separately 

[other 

86. Heat Provider Name Code (see Instructions) 

7. Heat Type Code (see instructions) 

8. 

2025 FILING STATUS: 

9. 2025 RESIDENCY STATUS: 

| 

*If you checked box “c,” enter dates of Michigan residency In 2025. 

Check one. 

Check all that apply. 

Enter dates as MM DD-YYYY. 

oye 

a 

fol Single 

a, gs Resident 

b. |_| Married filing jointly 

b. 

[_] Nonresident 

Married filing separately 

g 

’ 

Cc. 1 (Include Form 5049) 

c. 

[1 Part-Year Resident” 

10, Check the box if your heating costs are currently included in your 

15. 

rent (S8€ INSHUCHONS)...cuuumumesssiscsssssssssrmmnseamsssisssssmesisssssssesssssrens 

44_ 

Check the box if you want to be referred to other government 

) assistance programs for which you may qualify. 

coe 

Ja] 

12. Check the box if you or your spouse now receive 

Supplemental Security Income (SSI)......currmmnsesmireiesnnsennn 

Bal 

13, Amount you were billed for 

. 

7) 

heat between 11/01/2024 and 10/31/2025 ....... 

3 b A 

00 

14, 

If you lived in one of these CARE facilities (not a senior apartment 

complex) for all of 2025, check the box and STOP here, see instructions. 

a. | Nursing Home 

b. 

‘Adult Foster Care Home 

c. I Licensed Home for the Aged 

d. O Substance Abuse Center 

Exemptions. Enter the number that applies to you, 

your spouse, or your dependents and complete line 16 

below. See instructions if you are age 66 or older. 

Personal Exemption 

{ 

(You and your spouse only) «...., savanans eansssnanenns 

a) 

Deaf, Disabled or Blind.....ou.rme.n. 

b. 

/ 

Qualified Disabled Veteran ............ 

[2 

Number of children living with you: 

o Ages 2 and under.......cmrenins 

» Ages 3-5... 

€, 

® AGES B-18..cnrrcnrerenirnnivasrannns 

f) 

Dependent adults, other than 

your spouse, who! live with you....... 

g. 

Add lines 15a through 15g.......crceu 

h) 

A 

16. 

You MUST enter the required information below and check all relevant boxes for filer, spouse, and ll other household members 

(as applicable). Refer to the table below to find the available codes. Treasury is required to collect this information in accordance 

with the federal Low Income Home Energy Assistance Program (LIHEAP). 

44, 

N 

J] 

Ethnicity Codes 

cL 

Race Codes 

Gender Codes 

H (Hispanic, Latino, or Spanish Origins} 

A (American Indian or Alaska Native) 

W (White) 

M (Self-identified Male) 

N (Non-Hispanic, Latino or Spanish Origins) 

| S (Asian) 

R (Mult-Race: two or more of the listed options) | F (Self-Identified Female) 

U {Unknown) 

B (Black or African American) 

0 (Other) 

O (Other) 

P {Native Hawaliah or Other Pacific Islander) 

LS (Unknown) 

U (Unknown) 

Filer 

] Reg 

Filer Ethnicity Code 

Filer Race Code 

Filer Gender Code 

. 

U.S, citizen or qualified 

F 

alien 

+ 9999 2025 

37 

01 

27 

7

[ 

fl 

$025 MI-1040CR-7, Page 3 of 3 

Standard and Alternate Home Heating Credit Computations 

Files ull Social Secu Number I 

hl STANDARD CREDIT. Standard allowance from Table A (see instr) l.. 

36. 

& 1 =2 

00 

37. 

Multiply line 35 by 3.5% (0.035) (if negative, enter “0").. 

37. 

55 

00 

38. 

Subtract line 37 from line 36 for standard credit amount. If line 37 is 

HO 

greater than line 36, enter “0” ......uimieniisnenosmmsiens 

38. 

00 

39. 

If you checked the box on line 10, multiply the amount on line 38 by 50% (0.50). Enter here 

. 

and on line 44. (If approved, the final amount as shown on line 45 is issued as a check.)..ou.uzezee . 

39. 

00 

40. 

ALTERNATE CREDIT. Total heating costs from 

line 13 or $3,765 (WHICHEVEX iS 1858) ....uccvmusersersmmensssnssmssninsssnsnasnans 

40. 

=) 365 

00 

41. 

Multiply line 35 by 11% (0.11) (if negative, enter “0") w..coinercervervnssnnens 

41 

) Z/ 

00 

42. 

Subtract tine 41 from line 40. If line 41 is greater than line 40, enter “00 

42, 

3 594 

00 

43. 

Multiply line 42 by 70% (0.70) for alternate credit amount ........eerversoner 

43, 

3 51 / le 

Q0 

44. 

Ifyou completed line 39 enter that amount here, Otherwise enter the larger of lines 38 or 43 here.. 

44. 

A 57 ly 

00 

45, 

HOME HEATING CREDIT. Multiply line 44 by 60% (0.60) ...ccrmenmnrmnmsmicssmsmsnssnssronssssssssmssssssassasens 

45. 

] 57 2 

00 

46. 

You must check this box to receive a refund from your heat provider for any overpayment to your heat account, if 

eligible (see instructions). 

DIRECT DEPOSIT 

a, Routing Transit Number 

b. Account Number 

c. Type of Account 

ONLY fill out this section if your heat Is included 

* 

nt (you have completed line 10 and line 

Jsee instructions and complete a, b and ¢. 

1. [PRnecking 

2, 1 Savings 

Deceased Taxpayer. 

if Filer and/or Spouse died after December 31, 2024, enter dates below| 

as MM-DD-YYYY. ENTER DATE OF DEATH ONLY. 

Preparer Certification. 

/ declare under penalty of perjury that this 

return is based an all information of which | have any knowledge. 

Filer 

—_ 

— 

— 

— 

Spouse 

Taxpayer Certification, 

/ declare under penalty of perjury that the Information 

i in this refurm 

and attachments is true and complete to the best of my knowledge. 

Nchalle 

Filer's Signature 

Date 

pN 

Prepdrer's Signa 

Spouse's Signature 

Date 

i By checking this box, 

| authorize Treasury to discuss my return with my prepare] 

vo kee 

dint FRE5T 

YE 

834-6 I] 

Mail your claim to: Michigan Department of Treasury 

Lansing, Ml 48956 

+ 9999 2025 

37 

03 

27 

3

LAKE TRUST 

N 

4805 S Old US Highway 23 

Brighton, MI 48114-7521 

888.267.7200 | laketrust.org 

MICHELLE R MATHIS 

3065 ROANOKE ST 

FLINT MI 48504-1708 

Statement Period 

January 01, 2026 to January 31, 2026 

Account Balances at a Glance 

Total Savings 

$0.00 

Membership Savings 

Account Number: 

| NNR 

Summary 

Additional 

Beginning Balance (01/01) 

$0.00 

Average Daily Balance 

$0.00 

Deposits & Additions 

$0.00 

Annual % Yield Earned This Period 

0.00% 

Withdrawals 

$0.00 

Interest Paid Year-to-Date 

$0.00 

Ending Balance (01/31) 

$0.00 

Transactions 

{No franisactions oh this statement. 

Page 1

Employee 

Reference 

Copy 

Wage 

and 

Tax 

W-2 

Statement 

2025 

CapyC for emolves's regan 

o. 10450029 

Corp. | Employer use only 

‘Employer's name, address, and IP code 

GOODWILL INDUSTRIES OF M 

MID MICHIGAN INC 

501 

S. AVERILL AVE 

FLINT MI 48506 

exch [I 

off Employee's name, address, and ZIP colle 

RODERICK CHATMAN 

3065 ROANOKE STREET 

FLINT MI 48504 

b 

Empigeas 

er 

[a Em 

v 

1 

Wages, Ups, o 

| 

2 Foderal Income tax 

14367.38 

23.24 

3 

Soclal security wages 

4 

Social security tax withheld 

14367.38 

890.71 

5 

Medicare wages and tips 

| 6 Modicaro 

tax withheld 

14367.38 

208.35 

7 

Soclal security tips 

§ Allocated tips 

0 Dependant cara benafits 

17 

“|1za Seaiguclon for ex 12 

12b 

T 

14 Other 

12¢ 

T 

12d. 

[] 

2025 W-2 and EARNINGS SUMMARY /3 

1. Your Gross Pay was adjusted as follows to produce 

This blue section Is your Earnings Summary which provides more detailed 

information on the generation of your W-2 statement. The reverse side 

includes instructions 

and other general information. 

your W-2 Statement. 

‘Wages, Tips, other 

2, Employee Name and Address, 

Social Security 

Medicare 

ML. State Wages, 

MI-FLT 

Compensation 

Wages 

Wages 

Tips, Etc. 

Local Wages, 

Box 1 of W-2 

Box 3 of W-2 

Box 5 of W-2 

Box 160fW-2 

Tips, Etc. 

Box 18 of W-2 

Gross Pay 

14,435 ,30 

14,435.30 

14,435 .30 

14,435 .30 

14,435.30 

Less Other Cafe 125 

67.92 

67.92 

67.92 

67.92 

67.92 

Reported W-2 Wages 

14,367.38 

14,367.38 

14,367.38 

14,367.38 

14,367.38 

RODERICK CHATMAN 

3065_ROANOKE STREET 

FLINT 

MI 48504 

13 Stat omy] Re pan fird party sick pay] 

16 State] Employer's state ID no.[16 State wages, tips, etc. 

[1] 

14367.38 

17 State incoma tax 

18 Local wages, tips, etc. 

364.14 

14367.38 

18 Local incom tax 

|20 Locality 

name 

BO 2025 ADP, 

In 

137.65 

I-FLT 

" 

= Tips, other comp. 

|2 Federal Income tax withheld 

| 

[1 

Wagss, tips, other comp. 

[2 Fedaral income tax withheld 

1 

Wages, tips, othercomp. 

 |2 Federal income tax withheld 

14367.38 

23.24 

14367.38 

23.2 

14367.38 

23.2 

3 

Social security wages 

4 

Social security tax withheld 

3 

Social security wages 

4 

Social security tax withheld 

3 

Soclal secury ‘wa 

4 

Social security tax withheld 

14367.38 

90.7 

12367.38 

#90.71 

4367.38 

890.71 

§ 

Medicare — and tips 

6 

Medicare tax withheld 

§ 

Medicare ha 156 tips 

6 

Medicare tax withheld 

5 

Medicare — and tips 

6 

Medicare tax withheld 

14367.38 

08.35 

367.38 

208.35 

14367,38 

208.35 

d 

Control number 

Dept. 

| 

Corp. 

| 

Employer use only 

d 

Control 

Dept, | Corp. 

| 

Employer use only 

d 

Control number 

Dept. 

| 

Cop. | 

Employer use only 

119269 

PITT/MX5 

[703081 

A 

118269 

PITT/MX5 

703081 

A 

119269 

 PITT/MXS 

[703081 

A 

© 

Employer's name, address, and ZIP code 

GOODWILL INDUSTRIES OF M 

MID MICHIGAN INC 

501 

S. AVERILL. AVE 

FLINT Mi 48506 

7 

Social security tips 

B Allocated tips 

© 

Employer's name, address, and ZIP codo 

GOODWILL INDUSTRIES OF M 

MID MICHIGAN INC 

501 

S. AVERILL AVE 

FLINT MI 48506 

© 

Employer's name, address, and ZIP code 

GOODWILL INDUSTRIES OF M 

MID MICHIGAN INC 

501 

S. AVERILL AVE 

FLINT MI 48506 

8 

Allocated tips 

8 Allocated tips 

10 Dependent care benefits 

3 iependant cars beneiits 

0 Dependent care benefits 

pi fit party sick pay 

11 Nongualified plans 

12a See Instructions for box 12 

[12a 

11 Nongqualified plans 

122 

| 

| 

44 Other 

i 

14 Other 

Z 

14 Other 

7 

EI 

Ze 

ize 

8 

EEE 

Lal 

13 Stat emp] 

13 stat ene] 

anf ‘party sick pay] 

73 Stat any ipa. plan] [ party sick pay 

If Employes's nam, address and ZIP code 

RODERICK CHATMAN 

3065 ROANOKE STREET 

FLINT MI 48504 

olf Employee's name, address and ZIP code 

RODERICK CHATMAN 

3065 ROANOKE STREET 

FLINT MI 48504 

elf Employae's name, address and ZIP code 

RODERICK CHATMAN 

3065 ROANOKE STREET 

FLINT MI 48504 

15 stat 

D no.Ji6 State wages, tips, etc. 

15 State]Emplover's state Ib no16 State wages, tips, sic. 

15 State 

7 

tata wages, tips, etc. 

Ml 

14367.38 

[4 

14367.38 

mi 

14367.38 

17 State Income 

lax 

18 Local wages, tips, etc. 

17 State income tax 

18 Local wages, tips, etc. 

7 Stale incoma tax 

18 Local wages, tips, atc. 

364.14 

14367.38 

364.14 

14367.38 

364.14 

14367.38 

F Income tax 

20 Locality name 

79 Local Income tax 

20 Locality name 

19 Local Income tax 

[20 Locality name 

137.65 

MI-FLT 

137.65 

- 

137.65 

- 

Federal 

Filing 

Copy 

Mi.State 

Filing 

Copy 

City 

or 

Local 

Filing 

Copy 

Wage 

and 

Tax 

Wage 

and 

Tax 

Wage 

and 

Tax 

W-2 

Statement 

2025 

W-2 

Statement 

2025, 

W-2 

Statement 

2025 

Copy Bo be fled with employer's 

Federallncome TaxRapmc: 10 oo 

Copy 2to be fied with employee's State Income Tax Return. 

Capy 210 be fled with employes's City or Lacal_ Income Tax Rakin:

Case Name: 

Michelle Mathis 

GENESEE CO DHS CLIO RD DISTRICT 

case Number. [INE 

Date: 

02/03/2026 

PO BOX 1625 

FLINT MI 48501 

MDHHS Office: GENESEE CO DHS CLIO RD DISTRICT 

) 

x 

Specialist: 

M. Client-connection 

Save time - go online! 

Phone: 

(844) 464-3447 

Go to www.michigan.gov/mibridges/ to 

Fax: 

(517) 346-9888 

access your case online, or call (888) 642-7434. 

Specialist ID: 

MDHHS-Genesee-Clio 

If you do not understand this, call an MDHHS office in your area. 

STATE OF MICHIGAN 

MDHHS employees are prohibited by law from providing legal advice. 

. 

Si Gisted no entiende esto, llame a una oficina de MDHHS en su area. 

Department of Health and Human Services 

La ley prohibe a los empleados de MDHHS proporcionar asesoria legal. 

Lilia 

Ld 3 ga sell MDHHS Say Joald ollall 13 pd 

A pra ial 5 13) 

LA pA Asai) elas) MDHHS (ik 

se Sle O58) a5 

MICHELLE R MATHIS 

GENESEE CO DHS CLIO RD DISTRICT 

3065 ROANOKE ST 

PO BOX 1625 

FLINT MI 48504 

FLINT MI 48501 

NOTICE OF CASE ACTION 

Please read each page of this notice carefully. 

We have reviewed your application or case. The actions that affect your case are listed in this notice. 

Simplified Reporting: 

What this means for your household: 

If your gross income exceeds the simplified reporting income limit of $1696.00, you must report this change by 

the 10th day of the following month. If you fail to report this income change, you could lose your FAP benefits, or 

they may be reduced. 

See the simplified reporting section for more details. 

Access your case online to report changes: www.michigan.gov/mibridges. 

Benefit Summary 

(more information about your benefits follows this summary) 

FOOD ASSISTANCE PROGRAM 

DHS - 1605 (Rev.06-19) Bridges 

Page 10of 5 

over

Period 

Action 

Benefit 

01/01/2026 - 12/31/2026 

Approved 

$ 24.00/mo. 

More Information About Benefits 

SRS TN 

Be 

nT 

SESE 

seal 

For the month(s) of: 

Benefits are: 

Amount 

Who's Included 

01/01/2026 - 12/31/2026 

| APPROVED 

$ 24.00/mo. 

Michelle R Mathis 

If approved for cash assistance, your benefits may go down or stop. 

Your monthly income is based on your total income and expenses. Your expenses do not reduce your income 

dollar for dollar. The following amounts were used to determine your benefits: 

Monthly Income (after deductions) 

$1439.00 

BUDGET SUMMARY 

Earned Income 

80.00 

Self Employment Income 

0.00 

Unearned Income 

1601.00 

Standard Deduction 

209.00 

Homeless Shelter Deduction 

0.00 

Internet Deduction 

0.00 

Medical Expenses 

0.00 

Dependent Care 

0.00 

Child Support Payments 

0.00 

Housing Costs 

63.33 

Heat/Utility Standard (including phone) 

682.00 

Non-Heat Electric Standard 

0.00 

Water/Sewer Standard 

0.00 

Telephone Standard 

0.00 

Cooking Fuel Standard 

0.00 

Trash Standard 

0.00 

Benefits Withheld to Repay an Overissuance 

0.00 

SIMPLIFIED REPORTING 

Effective the date of this notice, you are only required to report for the Food Assistance program when you 

receive a lottery or gambling winning of $4,500 or more, or your household income exceeds the limit listed 

below. If you are subject to Time Limited Food Assistance work requirements, you are required to report when 

your hours of employment drop below 80 hours a month. 

Household Size: 

1 

DHS - 1605 (Rev.06-19) Bridges 

Page 2 of 5

LR 

Income Limit: $ 1696.00 

When must you report 

If your household has an increase in income (eamed or unearned), you must see if your household's gross* 

monthly income is now over the limit. At the end of the month, total your gross income and compare it to your 

monthly income limit. 

If your income is more than the limit mentioned above, you must report this to your 

specialist by the 10th of the following month. Whenever you do report a gross income amount that is over the 

limit for your household, be sure to say whether you think the increased income will continue beyond the report 

month. If your income is less than the amount mentioned above, you do not need to report the income change. 

*Gross income means the amount of all earned and unearned income before any deductions, such as taxes, are 

taken out. 

HEARING RIGHTS 

You hava the right to request a hearing if you do not agree with any action or decision the department makes 

(including failure to act with reasonable promptness). You can ask for a hearing for FAP by phone. Hearings for 

all other programs must be requested in writing. At the hearing you can explain why you disagree with the action 

or decision and present evidence. 

The request should include your name, address and case number. Attach a copy of this notice if possible. Go to 

http:/Aww.michigan.gov/-media/Project/Websites/mdhhs/Forms/DHS-18.dotx to download a form to use or 

contact local MDHHS office shown on the first page of this notice to request a form. 

~ Keep a copy of the request and any other document you attach for yourself. 

- MDHHS must receive your request for appeal within’ 90 days of the mailing date of this notice. Your request 

must be received on or before 05/04/2026 

or you will nat be granted a hearing. 

- MDHHS must receive your request for an appeal within 10 days of the mailing date of this notice to continue 

receiving your benefits. Return your request on or before 02/17/2026. 

You may be required to repay any assistance that you receive while your appeal is pending if 1) the 

department's proposed action Is upheld in the hearing decision, or 2) your request for appeal Is withdrawn, or 3) 

you or your autharized representative do not attend this hearing. 

You may choose anyone to represent you. If that person is not a lawyer or is not appointed by a court, you must 

give us your signed authorization. Attach a copy of the court's order if the person is court appointed to help you. 

The Michigan Administrative Hearing System (MAHS) will deny the request for an administrative hearing made 

by the representative if you do not provide proof of authorization. The authorized hearing representative needs 

to be authorized before they can make the request. 

This Institution is prohibited from discriminating on the basis of race, color, national origin, disability, age, sex 

and in some cases religion or political beliefs. 

DHS - 1605 (Rev.06-19) Bridges 

Page 3 of 5 

over 

IANA 

9674089000000 [lit

The U.S. Department of Agriculture also prohibits discrimination based on race, color, national origin, sex, 

religious creed, disability, age, political beliefs or reprisal or retaliation for prior civil rights activity in any program 

or activity conducted ar funded by USDA. 

Persons with disabilities who require alternative means of communication for program information (e.g. Braille, 

large print, audiotape, American Sign Language, etc.), should contact the Agency (State or local) where they 

applied for benefits. Individuals who are deaf, hard of hearing or have speech disabilities may contact USDA 

through the Federal Relay Service at (800) 877-8339. Additionally, program information may be made available 

in languages other than English. 

To file a program complaint of discrimination, complete the USDA Program Discrimination Complaint Form, 

(AD-3027), found online at: 

hitp:/Aww.ascr.usda.govicomplaint_filing_cust.htmi, and at any USDA office, or write a letter addressed to 

USDA and provide in the letter all of the information requested in the form. To request a copy of the complaint 

form, call (866) 632-9992, Submit your completed farm or letter to USDA by: 

(1) 

mail: U.S. Department of Agriculture 

Office of the Assistant Secretary for Civil Rights 

1400 Independence Avenue, SW 

Washington, D.C. 20250-9410 

(2) 

fax: (202) 690-7442; or 

(3) 

email: program.intake@usda.gov. 

For any other information dealing with Supplemental Nutrition Assistance Program (SNAP) issues, persons 

should either contact the USDA SNAP Hotline Number at (800) 221-5689, which is also in Spanish or call the 

State Information/Hotline Numbers (click the link for a listing of hotline numbers by State); found online at: 

http:/iwww.fns.usda.gov/. 

To file a complaint of discrimination regarding a program receiving Federal financial assistance through the u.s. 

Department of Health and Human Services (HHS), write: HHS Director, Office for Civil Rights, Room 515-F, 200 

Independence Avenue, S.W., Washington, D.C. 20201 or call (202) 619-0403 (voice) or (800) 537-7697 (TTY). 

This Institution is an equal opportunity provider. 

The Michigan Department of Health and Human Services (MDHHS) will not discriminate against any individual 

or group because of race, sex, religion, age, national origin, color, height, weight, marital status, sexual 

orientation, political beliefs or disability. If you need help with reading, writing, hearing, etc., under the Americans 

with Disabilities Act, you are Invited to make your needs known to a MDHHS office in your area. 

DHS ~ 1605 (Rev.06-19) Bridges 

Page 4 of 5

Case Name: 

Michelle Mathis 

Case Number: 

GENESEE CO DHS CLIO RD DISTRICT 

Date: 

02/03/2026 

PO BOX 1625 

MDHHS Office: GENESEE CO DHS CLIO RD DISTRICT 

FLINT M!48501 

NN 

Spedlalist: 

M. Client-connection 

3 

5 

Phone: 

(844) 464-3447 

B® 

Fax 

(517) 346-9888 

S 

 Specialistip: 

MDHHS-Genesee-Clio 

o 

If you do riot understand this, call an MDHHS office in your area. 

STATE OF MICHIGAN 

MoS employees are prohibited by law from providing legal advice. 

+ 

Usted 

no entiende esto, llame a una aficina de MDHHS en su area. 

Department of Health and Human Services 

La ley prohibe a los empleados de MDHHS properclonar asesoria legal. 

Llsilie 8 3a gall MDHHS GiSa Juotld adhd 130 aed 

8 3) soca cigal y 13) 

AE Aogealll sla) MDHHS (ili 

ge (lo Galil 25mg 

MICHELLE R MATHIS 

3065 ROANOKE ST 

FLINT MI 48504 

SIMPLIFIED SIX MONTH REVIEW 

Your household is a simplified reporting household. You will receive a form in the mail called a Semi- 

Annual Contact Report, 6 months from your application/redetermination date. 

You must fill the form out and return it to your specialist by the due date on the form. The form will 

explain what to fill out and where to mail it. Your specialist will use your completed form to decide if you 

Jil qualify for Food Assistance benefits (FAP) without having an interview. If help is needed to complete 

the form, contact your local office listed above. 

You will be asked to provide the following information: 

« 

CHANGE IN ADDRESS AND HOUSING EXPENSES - if you have moved and any of your housing 

expenses have changed. 

« 

CHANGE IN HOUSEHOLD MEMBERS - information about any people who have moved into or out 

of your household. 

! 

« 

CHILD SUPPORT PAYMENTS — proof of any changes in the legal obligation to pay child support. 

« 

HOUSEHOLD INCOME — if your household's earned income has changed by more than $125 or 

unearned income has changed by more than $125, you will need to provide proof of current income 

from the last 30 days. Sources of income include such things as Child Support, Unemployment, 

Worker's Compensation, Social Security Income, employment and self-employment. If someone is 

self-employed and has expenses, you will need to provide receipts to claim actual expenses. 

over 

DHS-1045 (Rev. 6-23) Bridges 

) 

ITA 

Cm 

~ 

pry 

© 

J 

op 

Oi 

b= 

©: 

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[= 

[=

Important Information - Please Read 

MiBridges Client Self-Service 

’ 

) 

The Michigan Department of Health and Human Services offers two client self-service options: 

* Applicants and recipients can obtain information about their case, review benefits and report changes directly 

to their MDHHS specialist on-line by visiting www.michigan.gov/mibridges. 

* In addition, case information can be obtained 24 hours a day by calling the automated information line at 

1-888-MiBridges (642-7434). 

Reporting Changes 

If you receive benefits for a cash assistance program, food assistance program, or child care it is your 

responsibility (or that of the person acting for you) to notify this office within 10 days of any changes in your 

circumstances which may affect your eligibility for assistance. This Includes changes in employment, income, 

assets and health insurance premiums for you or members of your family, the number of persons living in your 

home, college student status, and change of address. Failure to report changes may make you liable to 

penalties provided by law for fraud, Your MDHHS specialist will tell you if different reporting rules apply to you, 

such as simplified reporting. 

Free School Meals 

School-aged children who get FIP and/or FAP can also get free school meals if the school participates in the 

U.S. Department of Agriculture National School Lunch Program. Show this notice (Notice of Case Action) to 

school officials to verify your eligibility when asked, or to apply for free school meals. 

WIC (Women, Infants, and Children) 

If you are pregnant, recently had a baby or have children under the age of 5, your household may be eligible for 

WIC. Contact your local health department or call 1-800-842-1636 for more information. 

: 

Domestic Violence 

You are authorized to receive domestic violence comprehensive services. Contact the MDHHS office in your 

area or your MDHHS specialist for more Information. To access these services visit www.michigan.gov/ 

domesticviolence, or www.michigan.gov/dhs-publications to view MDHHS Publication-859, Is someone hurting 

you or your children? 

Bridge Card Information 

After you receive your first replacement card, your benefits may be reduced to cover the cost of replacing any 

additional cards. 

, 

Legal Help 

You might be able to get free legal help for your hearing request, To find help, call 888-783-8190 or go online to 

hitps:/fwww.michbar.org/public_resources/legalaid 

DHS - 1605 (Rev.06-19) Bridges 

Page 50f 5 

TRA An

’ 

i 

Case Name 

Case Number 

Specialist 

Michelle Mathis 

M. Client-connection 

e 

ASSETS — if your assets exceed $15,000. 

Yu must give us proof for most changes you report on the Semi-Annual Contact Report. To save 

your household time, be sure to save proof of income and other documents such as changes in 

the legal obligation to pay child support that verify your answers. 

Failure to return the form and proof of income will result in FAP case closure. 

Special assistance for individuals with 

a mental or physical disability and/or individuals needing help with 

reading, writing, hearing, etc., can be obtained by contacting your local office listed above. 

The Michigan Department of Health and Human Services (MDHHS) does not discriminate against any 

individual or group on the basis of race, national origin, color, sex, disability, religion, age, height, weight, 

familial status, partisan considerations, or genetic information. Sex-based discrimination includes, but is 

not limited to, discrimination based on sexual orientation, gender identity, gender expression, sex 

characteristics, and pregnancy. 

’ 

This institution is an equal opportunity provider. 

DHS-1045 (Rev. 6-23) Bridges 

}

Case Name: 

Michelle Mathis 

Case Number EGG 

Date: 

02/20/2026 

MDHHS Office: GENESEE CO DHS CLIO RD DISTRICT 

GENESEE CO DHS CLIO RD DISTRICT 

PO BOX 1625 

FLINT MI 48501 

Specialist/ ID: 

M. Client-connection / MDHHS-Genesee-Clio 

Phone: 

(844) 464-3447 

Fax: 

517) 346-9888 

Beneficiary ID: 

If you do not understand this, call an MDHHS office in your area. 

STATE OF MICHIGAN 

MDHHS employees are prohibited by law from providing legal advice. 

: 

Si Usted no entiende esto, lame a una oficina de MDHHS en su area. 

Department of Health and Human Services 

La ley prohibe a los empleados de MDHHS proporclonar asesor(a legal. 

lille ob 

3 en pall MDHHS cia) Joatlh calla) 138 gh od 4) gram gal 5 13) 

Ag gE dasa Uae) MDHHS ils 

ge Jo Opal pha 

MICHELLE R MATHIS 

3065 ROANOKE ST 

FLINT MI 48504 

HEALTH CARE COVERAGE DETERMINATION NOTICE 

If you have previously received a determination notice regarding health care coverage for individuals not 

listed on this notice, their coverage has not changed. 

Denial / Closure Information 

Below are the reason(s) for the intended action. 

04/01/2026 - Ongoing- Michelle R Mathis is not Eligible (Medicare Savings Program) 

-Verification of Bank Account Saving (BEM 400) was not returned for Michelle R Mathis. 

Manual Item(s): BAM 130 

Internal use only code: DI4003 

The income below was used in determining the Health Care Coverage for Michelle R Mathis 

More information about your Denial / Closure 

DHS - 1606 (Rev.03-19) Bridges 

Page 

1 of 3 

over 

NAN19230KRNNNARRN2NTNN

If you believe you or anyone who was denied/closed for health care coverage has consumed water from the Flint 

water system AND lived, worked, or received childcare or education at an address that was served by the Flint 

water system at any time from April 2014 through present day, please reapply on MI Bridges. 

The Medicare Savings Program will stop paying Medicare premiums. 

If you are eligible for another Medicare 

Savings Program benefit a separate eligibility determination is listed below. 

Medicare is the federal medical insurance program administered by the Social Security Administration (SSA). 

Medicare Savings Program helps pay Medicare premiums. It may also pay Medicare coinsurances and 

deductibles. Medicaid is the state medical assistance program. Medicare Savings Program and Medicaid are 

administered by the department of Health and Human Services. Some people receive both Medicare Savings 

Program and Medicaid. 

Household size income limits are printed below. 

If the household member is 

Household size 

Age 0-18 

Between age 19 - 64 

Pregnant 

Flint Water Group 

1 

$ 33,178.00 

$20,814.50 

$30,517.50 

$ 62,600.00 

2 

$ 44,838.00 

$ 28,129.50 

$41,242.50 

$ 84,600.00 

3 

$ 56,498.00 

$ 35,444.50 

$51,967.50 

$ 106,600.00 

4 

$ 68,158.00 

$ 42,759.50 

$ 62,692.50 

$ 128,600.00 

9 

$79,818.00 

$ 50,074.50 

$73,417.50 

$ 150,600.00 

6 

$91,478.00 

$ 57,389.50 

$ 84,142.50 

$ 172,600.00 

7 

$103,138.00 

$ 64,704.50 

$94,867.50 

$ 194,600.00 

8 

$ 114,798.00 

$72,019.50 

$ 105,592.50 

$216,600.00 

9 

$ 126,458.00 

$79,334.50 

$116,317.50 

$ 238,600.00 

10 

$138,118.00 

$ 86,649.50 

$ 127,042.50 

$ 260,600.00 

The Michigan Department of Health and Human Services (MDHHS) does not discriminate against any individual 

or group because of race, religion, age, national origin, color, height, weight, marital status, genetic information, 

sex, sexual orientation, gender identity or expression, political beliefs or disability. 

DHS - 1606 (Rev.03-19) Bridges 

Page 2 of 3

of Account 

FAN, 

gp 

Frankenmuth Credit Union 

Frankenmuth 

(989) 497-1600 800-221-3880 

Jy 

r} 

580 N Main St 

Credit Union 

PD Box 208 

Rh 4 

Frankenmuth MI 48734 

Please keep this December year end statement for 

your tax records. Remember that your 1099-INT info 

is on this statement & no separate mailing will be 

sent. Also, the fair market value of your IRA & 

RODERICK L. CHATMAN 

all tax information is being provided fo the IRS. 

3065 ROANOKE ST 

FLINT, MI 48504-1708 

- MEMBERSHIP SUMMARY INFORMATION FOR MEMBER # 128510 

AS OF 

12/31/25 

YOU EARNED 120 V.I.P. POINTS; YOUR NEW LEVEL WILL BE: VIP-SILVER 

MOVE UP TO GOLD OR PLATINUM LEVELS FOR ADDED REWARDS - ASK US HOW! 

Beginning 

Suffix 

Account Description 

Balance 

Total Debits 

Total Credits 

Ending Balance 

Last Tran 

000 

REGULAR SAVINGS 

00 

[00 

5.00 

5.00 

12/09/25 

064 

KASASA CSHBK SAVER 

00 

.00 

00 

00 

9/03/25 

110 

KASASA CSHBK PLUS 

16 

769.04 

886.75 

117.87 

12/31/25 

000: REGULAR SAVINGS 

Year-to-Date Divd Paid: 

$.00 

Divd Rate: 

100.00 to 

9,098.99 = 

0.02% 

10,000.00 to 

24,999.99 = 

0.02% 

25,000.00 to 

99,999.99 = 

0.02% 

100,000.00 to 999,999,999.99 = 

0.02% 

) 

.01 

to 999,999,999.99 = 

.01 

to 999,999,999.99 = 

.01 

to 999,999,998.99 = 

0.00 to 999,999,099.99 = 

Transaction Detail 

Date 

Transaction Type 

#/ID 

Transfer Acct 

Deposit 

Withdrawal 

Balance 

12/01/25 

* Beginning Balance * 

$.00 

12/09/25 

PC CU TRANSFER 

128510-110 

$5.00 

$5.00 

12/31/25 

** Ending Balance ** 

$5.00" 

$.00* 

$5.00 

064: KASASA CSHBK SAVER 

Year-to-Date Divd Paid: 

$.01 

0.00 to 999,998,999.99 

.01 

to 999,998,999.99 

.01 

to 999,999,9990.99 

.01 

fo 999,999,999.99 

Acoli; 

Last Trans Date: 8/03/25, 

hong 

110: KASASA CSHBK PLUS 

+ pepe 

SET 

.01 

to 999,999,999.99 

.01 

to 999,899,999.99 

.01 

to 999,998,989.99 = 

un 

0.00 to 998,999,999.99 = 

Year-to-Date Divd Paid: 

$.00 

0.00 

fo 998,998,999.99 = 

.01 

fo 999,999,999.89 = 

.01 

to 999,999,990.99 = 

01 

to 999,999,990.99 = 

.01 

to 999,999,989.99 = 

.01 

to 999,999,990.99 = 

.01 

to 999,099,999.99 = 

0.00 to 999,999,999.99 = 

Transaction Detail 

) 

Date 

Transaction Type 

#D 

Transfer Acct 

Deposit 

Withdrawal 

Balance 

J 

12/01/25 

* Beginning Balance * 

$.16 

12/01/25 

ID Protection 

JX 

$3.00- 

$-2.84

FRANKENMUTH CREDIT UNION 

) 

) 

member [JJ ropzrick L criarman 

Page 2 of 4 

Date 

Transaction Type 

#1D 

Transfer Acct 

Deposit 

Withdrawal 

-+ 

Balance 

12/04/26 

ATM/DEP#00000007168% 

9013 : & Other 

$140.00 

$137.16 

DORT FINANCIAL CU FLINT MI 5091 W PIERSON RD 

12/05/25 

DBTWDR 120400087617 

“9813 : MULTIPLE 

$09.34 

$37.82 

CASH APP*THEEKINGKED Oakland CA 1955 Broadway 

12/05/25 

 DBTAMDR 30013287369 

+9013 : & Other 

$34.95- 

$2.67 

ACPCREDIT ONE BANK, LAS VEGAS NV 585 PILOT RD 

12/07/25 

 ATM/DEPH#00000008075% 

+9013 : & Other 

$100.00 

$102.87 

DORT FINANCIAL CU FLINT MI 5091 W PIERSON RD 

12/00/25 

 DBTWDR*20343844571 

+9013 ; 4 Entertainment 

$847. 

$94.40 

APPLE.COM/BILL CUPERTINO CA ONE APPLE PARK WAY 

12/00/25 

PC CU TRANSFER 

128510-000 

$500- 

$89.40 

12/00/25 

~~ DBTMWDR*20359125101 

*9013 : ¢ Entertainment 

5053 

$79.87 

APPLE.COM/BILL CUPERTINO CA ONE APPLE PARK WAY 

1210/25 

~~ DBTAWDR#57589432016 

9013 : # Restaurant 

$7.94 

$71.93 

ARBYS 0984 FLINT MI G-4325 W PIERSON RD 

12111125 

 POS/WDR#000067046537 

+9013 ; §¥ Merch / Supp 

$0.51 

$6242 

QUICK PICK PARTY STO FLINT MI 3189 W PASADENA AVE 

1212/25 

 POS/WDR 121212465170 

+9013 

: e» Transportation 

$26.44- 

$36.28 

SPEEDWAY 44480 FLINT M 

) 

1212/25 

 DBTANDR#000043478492 

+9013 : 1 Restaurant 

§7.00- 

$28.38 

CHICK-FIL-A #05198 FLINT M| 3140 MILLER ROAD 

1213/25 

~~ DBTAWDR'20500388178 

+9013 : 

Entertainment 

$299- 

$25.39 

APPLE.COM/BILL CUPERTINO CA ONE APPLE PARK WAY 

12/1325 

 DBT/WDR#000043684115 

9013 : 

Restaurant 

$7.90 

$17.49 

CHICK-FIL-A #05198 FLINT Ml 3140 MILLER ROAD 

12/13/25 

 DBTAWDR000043684283 

*9013 : 

Restaurant 

516.75 

$.74 

CHICK-FIL-A #05198 FLINT Ml 3140 MILLER ROAD 

1218/25 

 ATM/DEP#00000000739% 

+5013 : R Other 

$395.00 

$395.74 

DORT FINANCIAL CU FLINT Mi 5091 

W PIERSON RD 

12/19/25 

~~ DBT/WDR'S8640104322 

#9013 . 8 Other 

$384.48 

$11.26 

OBP* TRUE COMM CRED JACKSON Mi 1100 CLINTON ROAD 

- 

12/20/25 

 DBTAVDR 122000020800 

+9013 : MULTIPLE 

$11.26- 

$.00 

CASH APP*CHE CHATMAN Oakland CA 1955 Broadway 

12/23/25 

 ATM/DEP#00000002151$ 

“9013 : & Other 

$20.00 

$20.00 

DORT FINANCIAL CU FLINT MI 5091 W PIERSON RD 

12/23/25 

~~ OCT/DEP 122300082882 

“9013 : 

® Other 

$4.75 

$24.75 

CASH APP*THEEKINGKED Oakland CA 

12/23/25 

 POSMDRH000024048720 

©9013 : & Merch / Supp 

$051 

$15.24 

QUICK PICK PARTY STO FLINT Mi 3169 W PASADENA AVE 

12/24/25 

 DBTWDR 122300067272 

“9013 : MULTIPLE 

$500- 

$10.24 

CASH APP*THEEKINGKED Oakland CA 1855 Broadway 

12/24/25 

~~ DBTAVDR*20039117346 

+9013 : 4 Entertainment 

$8.47- 

$1.77 

APPLE.COM/BILL CUPERTINO GA ONE APPLE PARK WAY 

12124125 

PC CU TRANSFER 

YXOOXXTE 

$10.00 

$11.77 

TOILET 

12/26/25 

PC CU TRANSFER 

KXRXRXXTS- 

$10.00- 

$1.77 

MICHELLE R MATHIS 

12/29/25 

PC CU TRANSFER 

XKOOXTE- 

3100.00 

$101.77 

FOOD TOILET PAPER NEW YEAR 

12/29/25 

 POS/WDR#122920000007 

*9013 1 ¥* Merch / Supp 

$100.90- 

5.87 

KROGER #419 FLUSHING Mi 

12/31/25 

 ATM/DEP#000000042175 

9013 : @ Other 

$117.00 

$117.87 

DORT FINANCIAL CU FLINT MI 5091 

W PIERSON RD 

12/31/25 

 ** Ending Balance * 

$886.75" 

$760.04 

$117.87 

Total NSF FEE summary this period: 

.00 

Total Year-to-Date: 

140.00 

Total BOUNCE PROTECT FEE summary this period: 

.00_Total Year-to-Date: 

00 

ANNUAL ACCOUNT INFORMATION FOR 2025 

This section Is intended to provide a general summary of your dividend and interest activity for the year, and is not intended to replace any standard IRS 

forms you receive for tax reporting purposes.

FRANKENMUTH CREDIT UNION 

Member #: I 

<o-= 

L CHATMAN 

Page 3 of 4 

3 DIVIDENDS EARNED IN 2025 

ACCOUNT | 

KASASA GSHBK SAVER 

$.01 

Total Dividends Earned for 2025: 

$.01 

Disclosures 

Loan number(s) followed by an asterisk (*) are open end credit accounts. With regard to those accounts, the balance subject to interest rate (shown in 

the "Balance" column) is the unpaid balance each day after credits are subtracled and the new advances or charges are added, The Finance Charge is 

computed on the dally outstanding balance by applying the dally periodic rate to the balance for the exact number of days such balance remains 

outstanding. The outstanding balance Is shown In the columns marked balance and the dally periodic rate is disclosed after the account number. The 

ANNUAL PERCENTAGE RATE, which is determined by multiplying the Daily Periodic Rate by the number of periods in the year (365), is likewise 

disclosed after the account number. 

Your savings are federally insured to at least $250,000 and backed by the full faith and credit of the United States Govemment,

FRANKENMUTH CREDIT UNION 

B FORM 1099-4 

member + JJ RODERICK L CHATMAN 

THIS IS YOUR FORM 1098-INT. YOU WILL NOT RECEIVE A SEPARATE FORM 1088-INT IN THE MAIL. 

ALL IRA ACTIVITY AND LOAN INTEREST WILL BE REPORTED ON 

STANDARD [RS FORMS AND WILL BE SENT IN A SEPARATE MAILING. 

580 N MAIN ST 

PO BOX 209 

989-497-1600 

PAYER'S name, street address, city or town, province or state, country, 

ZIP or foreign postal code, and telephone no. 

FRANKENMUTH CREDIT UNION 

FRANKENMUTH, MI 48734-0000 

2025 

Interest Income 

Copy B 

Form 1099-INT 

OMB ~ 

For Recipient 

PAYER'S federal identification 

number 

RECIPIENT'S identification numbes 

This is important tax information and is being furnished to 

the Internal Revenue Service. If you are required to file a 

return, a negligence penalty or other sanction may be 

imposed on you if this income is taxable and the IRS 

determines that it has not been reported. Please retain this| 

form for your records. 

See 1099-INT Instructions for Recipient on an enclosed 

form. 

3 

$.01 

Lo 

_ 

nterest 

Income not included in Box 

2 Early withdrawal 

3 Interest on L).S, Savings Bonds and Treas, 

penalty 

$.00 

4 Federal income tax 

obligations 

withheld 

$.00 

$.00 

Page 4of4

PERIOD ENDING 

VC 

RECONCILEMENT OF CHECK ACCOUNT 

CHECKS OUTSTANDING 

TO RECONCILE YOUR ACCOUNT 

CHECK NO. 

AMOUNT 

1. ENTER YOUR NEW BALANCE SHOWN ON THIS STATEMENT. 

5 

ADD 

2. MATCH DEPOSITS MADE WITH DEPOSITS SHOWN ON THIS 

STATEMENT. FIND THE TOTAL OF ANY DEPOSITS MADEAND 

 ¢ 

3y 

NOT SHOWN ON THIS STATEMENT, 

SUBTOTAL 

$ 

3. GO THROUGH YOUR CHECK COPIES OR CHECK REGISTER 

SUBTRACT 

AND MARK OFF EACH CHECK THAT 1S SHOWN AS PAID ON 

THIS STATEMENT, 

ENTER ALL UNPAID CHECKS IN THE 

CHECKS OUTSTANDING GOLUMN AND ADD THEM. SUBTRACT 

 g 

THE TOTAL OF THE OUTSTANDING CHECKS. 

ADJUSTED STATEMENT 

BALANCE 

$. 

4. SHOW YOUR END OF PERIOD CHECKBOOK BALANCE. 

$. 

5. CHECK YOUR STATEMENT FOR THE DIVIDEND INTEREST AND 

ADD 

OTHER SPECIAL ADDITIONS TO YOUR ACCOUNT; IF ANY, ADD 

THESE TO YOUR CHECKBOOK BALANCE IF YOU HAVE NOT AL- 

READY DONE SO. 

$. 

SUBTOTAL 

$ 

6. IF ANY SPECIAL CHARGES (SUBTRACTIONS) ARE SHOWN ON 

SUBTRACT 

YOUR STATEMENT (CHARGES FOR A NEW SUPPLY OF 

CHECKS, FOR STOP PAYMENT, FOR OVERDRAFT, FOR PREAU- 

THORIZED PAYMENT, ETC.), DEDUCT THESE CHARGES IF YOU 

HAVE NOT ALREADY DONE SO. 

$ 

ADJUSTED STATEMENT 

BALANCE 

$. 

' 

IF YOU DO NOT BALANCE 

1, 

Verify additions and subtractions both here and in your check register or on 

your check copies. 

2. 

Compare the check dollar amount shown on your statement with the amounts 

shown on your check copies or in your check register. 

3. 

Compare deposits shown on the statement with deposits recorded on your 

TOTAL 

check 

copies or in your register. 

) 

A. THE FOLLOWING IS APPLICABLE ONLY TO AN OPEN-END LOAN ACCOUNT. AN OPEN-END LOAN ACCOUNT IS IDENTIFIABLE BY AN 

ASTERISK (*) PRINTED AFTER THE ACCOUNT SUFFIX(ES) IN THE LOAN ACCOUNTS SECTION OF THIS STATEMENT. 

In Case of Errors or Questions About Your Statement 

1f you think your statement is wrong, or if you need mare information about a transaction on your statement, write us (on a separate sheet) at the address shown on 

the first page of this statement as soon as possible. We must hear from you no later than 60 days after we sent you the FIRST statement on which the error or 

problem appeared. You can telephone us, but doing so will not preserve your rights. 

In your letter, give us the following information: 

« Your name and account number. 

« The dollar amount of the suspected error. 

N 

. 

. 

« Describe the error and explain, if you can, why you believe there is an error. 

If you need more information, describe the item you are unsure about. 

You do not have to pay any amount in question while we are investigating, but you are still obligated to pay the parts of your statement that are not In question. 

While we Investigate your question, we cannot report you as delinquent or take any action to collect the amount you question. 

Special Rule for Credit Card Purchases 

If you have a problem with the quality of goods or services that you purchased with a credit card, and you have tried In good faith to correct the problem with the 

merchant, you may not have to pay the remaining amount due on the goods or services. You have this protection only when the purchase price was more than 

$50 and the purchase was made in your home state or within 100 miles of your mailing address. 

(If we own or operate the merchant, or if we mailed you the 

advertisement for the property or service, all purchases are covered regardless of amount or location of purchase.) 

THE FOLLOWING PROCEDURE 1S APPLICABLE ONLY TO YOUR ELECTRONIC FUNDS TRANSFERS. 

In Case of Errors or Questions About Your Electronic Transfers * 

Telephone or write us at the address or 

phone number shown on the first page of this statement as soon as you can If you think your statement or receipt is wrong 

or if you need more information about a 

transfer listed on the statement. We must hear from you no later than 60 days after we send you the FIRST statement on 

which the problem or error appeared. 

1. 

Tell us your name and account number (if any). 

, 

5 

2. Describe the error or the transfer you are unsure about, and explain as clearly as you can why you believe it is an error or why you need more information. 

3, Tell us the dollar amount of the suspected error, 

If you tell us orally, we may require that you send us your complaint or question in writing within ten (10) business days. 

We will tell you the results of our investigation within ten (10) business days after 

we hear from you and will correct any error promptly. 

If we need more time, 

however, we may take up to 45 business days™ to investigate your complaint or question, 

If we decide to do this, we will credit your account within ten (10) 

business days™* for the amount you think is in error, so that you have use of the money during the time it takes us to complete our investigation. 

If we ask you to 

put your complaint ar question in writing and we do not receive it within the ten (10) business days, we may not credit your account. 

) 

If we decide that there was no error, we will send you a written explanation within three business days after we finish our investigation. You may ask for copies of 

the documents that we used in our investigations. 

* This error correction procedure does not apply to business accounts or to business transactions performed via your account. Trust accounts and custodial 

accounts are exempt from this procedure in some states, 

If you give notice of an error within 30 days after you make your first deposit to your account involving a point of sale transaction, or notice of error involving a 

transaction initiated outside the United States, its possessions and territories, we will have 90 days instead of 45 days to perform our investigation. 

*= |f you give notice of an emor within 30 days after you make your first deposit to your account, we will have 20 business days instead of 10 business days to credit your account.

Statement of Account 

i 

p 

Frankenmuth Credit Union 

Frankenmuth 

{988) 497-1600 800-221-8880 

Credit Union 

580 N Main St 

PO Box 208 

v 

Frankenmuth MI 48734 

Please keep this December year end statement for 

your lax records. Remember that your 1099-INT info 

is on this statement & no separate mailing will be 

senl. Also, the fair market value of your IRA & 

MICHELLE R MATHIS 

all tax information is being provided to the IRS. 

3065 ROANOKE ST 

FLINT, Ml 48504-1708 

MEMBERSHIP SUMMARY INFORMATION FOR MEMBER # 

YOU EARNED 205 V.I.P, POINTS; YOUR NEW LEVEL WILL BE: VIP-GOLD 

MOVE UP TO PLATINUM FOR ADDED REWARDS - ASK US HOW! 

Suffix Account Description 

Beginning 

Total Debits 

Total Credits 

Ending Balance 

Last Tran 

000 

REGULAR SAVINGS 

5.00 

200.00 

200.00 

500 

12/09/25 

064 

KASASA CSHBK SAVER 

216.07 

517.00 

318.66 

1773 

12/31/26 

111 

KASASA CASHBACK 

1327.25 

2,834.28 

2,866.63 

1,350.60 

12/31/25 

645 

SIGN LN-SECURE 

3,394.47 

‘0 

30.60 

330447 

12/05/25 

000: REGULAR SAVINGS 

Year-to-Date Divd Paid: 

$.00 

} 

Divd Rate: 

100.00 fo 

9,999.99 = 

002% 

10,000.00 fo 

24,900.99 = 

0.02% 

25,000.00 to 

99,090.99 = 

0.02% 

100,000.00 to 999,999,999.99 = 

0.02% 

.01 

to 998,998,990.09 = 

.01 

to 998,899,999.99 = 

.01 

to 999,999,009.99 

= 

0.00 to 999,999,990.99 = 

Transaction Detail 

Date 

Transaction Type 

#ID 

Transfer Acct 

Deposit 

Withdrawal 

Balance 

1201125 

* Beginning Balance * 

* 

$5.00 

12/07/25 

ATM/DEP#00000008138% 

**3416 : & Other 

$200.00 

$205.00 

DORT FINANCIAL CU FLINT MI 5091 W PIERSON RD 

12/09/25 

PC CU TRANSFER 

111776-064 

$200.00- 

$5.00 

RENT 

12/31/25 

** Ending Balance ** 

$200.00* 

$200.00 

$5.00 

064: KASASA CSHBK SAVER 

Year-to-Date Divd Paid: 

$9.29 

0.00 to 998,999,999.99 = 

.01 

to 998,999,999.99 = 

01 

to 999,099,999.99 = 

.01 

to 998,899,999.99 = 

01 

to 999,999,999.99 = 

.01 

to 999,999,999.99 = 

.01 

to 999,999,999.99 = 

0.00 

to 899,999,990.99 = 

Dividend pald on 1/01/26 in the amount of $.53 

Transaction Detail 

Date 

Transaction Type 

#1D 

Transfer Acct 

Deposit 

Withdrawal 

Balance 

12/01/25 

* Beginning Balance * 

$216.07 

12/01/25 

SHARE DIVIDEND 

$1.14 

$217.21 

Your Annual Percentage Yield Eamed (APYE) is 3.00% based on an Average 

Balance of $469.53 for the 30 day period ending 12/01/25 

12/01/25 

DEBIT ROUND UP 

111776-111 

$0.78 

$217.99 

12/02/25 

DEBIT ROUND UP 

111776-111 

$0.19 

$218.18 

12/05/25 

DEBIT ROUND UP 

111776-111 

$0.18 

$218.36 

) 

12/06/25 

DEBIT ROUND UP 

111776-111 

$0.01 

$218.37 

12/09/25 

PC CU TRANSFER 

111778-000 

$200.00 

$418.37 

RENT

FRANKENMUTH CREDIT UNION 

hb] 

Date 

Transaction Type 

#1D 

12/09/25 

DEBIT ROUND UP 

12/10/25 

DEBIT ROUND UP 

12/11/25 

REMOTE CAPTURE 

90 

RDC AUTO-POST 

12/11/25 

DEBIT ROUND UP 

12/12/25 

DEBIT ROUND UP 

12/14/25 

DEBIT ROUND UP 

12/15/25 

DEBIT ROUND UP 

12/16/25 

DEBIT ROUND UP 

12/17/25 

REMOTE CAPTURE 

90 

. 

RDC AUTO-POST 

12/17/25 

DEBIT ROUND UP 

12/19/25 

PC CU TRANSFER 

BOUNCE FEE 

12/19/25 

PC CU TRANSFER 

COMPUTER BUY 

12/19/25 

PC CU TRANSFER 

WALMART PC 

12124125 

DEBIT ROUND UP 

12/25/25 

DEBIT ROUND UP 

12/28/25 

DEBIT ROUND UP 

12/28/25 

DEBIT ROUND UP 

12/29/25 

DEBIT ROUND UP 

12/30/25 

DEBIT ROUND UP 

12/31/25 

CashBack Reward 

12/31/25 

DEBIT ROUND UP 

12/31/25 

** Ending Balance ** 

111: KAS 

CSHBK 

PLUS 

Year-to-Date Divd Paid: 

0.00 

fo 999,999,999.99 

01 

to 999,999,999.99 

01 

to 899,999,899.98 

.01 

fo 899,999,099.99 

Transaction Detail 

Date 

12/01/25 

12/01/25 

12/01/25 

12/01/25 

12/01/25 

12/01/25 

12/01/25 

12/02/25 

12/02/25 

12/02/25 

12/02/25 

12/02/25 

12/02/25 

12/03/25 

12/03/25 

12/03/25 

J 

12/03/25 

Transaction Type 

#D 

* Beginning Balance * 

ID Protection 

JX 

DBT/WDR#00162666864 

**3416 : & Merch / Supp 

QUICK PICK PARTY STO FLINT M! 3169 W PASADENA AVE 

DBT/WDR 24452506613 

**3416 : & Merch / Supp 

EJM*BUG MD NEWPORT BEAC CA 501 Quail Street 

ACH/COMCAST-XFINITY 

CABLE SVCS 

ACH/AFFIRM.COM PAYME 

AFFIRM.COM 

DEBIT ROUND UP 

DBT/WDR 533602036918 

Paramount+ West Hollywoo CA 700 N San Vicente Bl 

DBT/WDR*50001014635 

**3416 : # Entertalnment 

HELP.HBOMAX.COM NEW YORK NY Warner Media 30 Huds 

POS/RFD 20085945156 

“3416 : # Services 

BRISTOL WEST INSURAN PLANTATION FL 900 S. Pine Island R 

POS/WDR 120222065273 

**3416 : w Transportation 

SPEEDWAY 44479 FLINT MI 

POS/WDR#000088877189 

**3416 : % Merch 

/ Supp 

WAL-MART #1928 FLINT MI 4313 CORUNNA RD 

DEBIT ROUND UP 

DBT/WDR 01756237773 

**3416 : 

Merch / Supp 

NEW SAMS.COM MEM# 888-746-7726 AR 608 SW 8TH ST 

DBT/WDR*20105113305 

**3416 : & Merch / Supp 

TME'TIME NEW YORK NY 225 LIBERTY ST 

DBT/WDR*20105113227 

**3416 : ¥ Merch 

/ Supp 

TME*ESSENCE NEW YORK NY 225 LIBERTY ST 

DBT/WDR*20105113238 

“43416 : & Merch / Supp 

TME*Family Handyman NEW YORK NY 225 LIBERTY ST 

wemser J MICHELLE R MATHIS 

.01 

to 999,899,809,99 = 

.01 

to 999,999,999.99 = 

.01 

fo 999,908,999.99 = 

0.00 fo 999,999,999.99 = 

Transfer Acct 

**3416 

; ~ Communications I 

Deposit 

Withdrawal 

$0.01 

$0.79 

$55.00 

$4.26 

$0.01 

$0.12 

$0.46 

$1.33 

$36.81 

$0.04 

$100.00- 

$300.00- 

$117.00- 

$0.20 

$0.92 

$0.59 

$3.00 

$1.28 

$0.36 

$10.00 

$1.18 

$318.66 

$517.00* 

Deposit 

Withdrawal 

$3.00- 

$8.44- 

$131.78- 

$14.95 

$54.25- 

$0.78- 

$2.99- 

$2.69- 

$0.34 

$25.00- 

$101.83- 

$0.19- 

$20.00- 

$2.00- 

$2.00- 

$2.00- 

Page20f7 

Balance 

$418.38 

$419.17 

$474.17 

$478.43 

$478.44 

$478.56 

$479.02 

$480.35 

$517.16 

$517.20 

$417.20 

$117.20 

$.20 

$.40 

$1.32 

$1.91 

$4.91 

$6.19 

$6.55 

$16.55 

$17.73 

$17.73 

Balance 

$1,327.25 

$1,324.25 

$1,315.81 

$1,184.03 

$1,169.08 

$1,114.83 

$1,114.05 

$1,111.06 

$1,108.07 

$1,108.41 

$1,083.41 

$981.58 

$981.39 

$961.39 

$050.39 

$057.39 

$955.30

FRANKENMUTH CREDIT UNION 

Member z 

| MICHELLE R MATHIS 

Date 

12/03/25 

12/04/25 

12/05/25 

12/05/25 

12/05/25 

12/05/25 

12/06/25 

12/06/25 

12/07/25 

12/08/25 

12/09/25 

12/09/25 

12/09/25 

12/10/25 

12/10/25 

12/10/25 

12/10/25 

12/10/25 

12/11/25 

12/11/25 

~~” 

12/11/25 

12/11/25 

12/11/25 

12/11/25 

12/11/25 

1211/25 

12/11/25 

12/11/25 

12/11/25 

12/12/25 

12/12/25 

12/12/25 

12/14/25 

12114125 

12/15/25 

12/15/25 

12/16/25 

12/16/25 

12/16/25 

J} 

12mens 

12/17/25 

Transaction Type 

#ID 

Transfer Acct 

Deposit 

DBT/WDR*20105113317 

**3416 : #% Merch 

/ Supp 

TME*Vanity Fair NEW YORK NY 225 LIBERTY ST 

ACH/CONSUMERS ENERGY 

ENERGYBILL 

SKIP A PAY FEE 645 

BF 

INT DUE FOR SKIP 45 

BF 

DBT/WDR#50031743185 

**3416 

; Ww Restaurant 

TST* INCREDIBLE BURG NOVI MI 27500 NOVI RD # FC10 

DEBIT ROUND UP 

DBT/WDR*533921142176 

**3416 : + Communication: 

Peacock 88ECG Premiu New York NY 30 Rockefeller Plaza 

DEBIT ROUND UP 

POS/WDR#120722100008 

**3416 : 5 Merch 

/ Supp 

KROGER #419 FLUSHING Mi 

ACHIAFFIRM.COM PAYME 

AFFIRM.COM 

DBT/WDR"20363941496 

**3416 : 

Entertainment 

APPLE.COM/BILL. CUPERTINO CA ONE APPLE PARK WAY 

ACH/ONCOURSE HOME SO 

$274.85 

OHS-120920 

DEBIT ROUND UP 

DBT/WDR#34083613108 

**3416 : 11 Restaurant 

CHIPOTLE 1158 ANN ARBOR Mi 858 BRIARWOOD CIRC # 

DBT/WDR#20399806292 

**3416 

: tt Restaurant 

SQ *SWEETING-MALL Ann Arbor MI 854 Briarwood Clr 

DBT/WDR 50001748762 

**3416 : 4 Entertainment 

STARZ ENTERTAINMENT ENGLEWOOD CO 8900 Liberty Circle 

ACH/AFFIRM.COM PAYME 

AFFIRM.COM 

DEBIT ROUND UP 

DBT/WDR#00182178370 

**3416 : 2 Merch / Supp 

QUICK PICK PARTY STO FLINT MI 3169 W PASADENA AVE 

DBT/WDR*50024630000 

**3416 : 

#% Merch / Supp 

PROTON AG GENEVA DU Route de la Galaise 

POS/MWDR#121114345400 

**3416 : © Merch 

/ Supp 

KROGER #759 WHITE LAKE Mi 

POS/WDR#121116500061 

*+3416 : % Merch / Supp 

KROGER #759 WHITE LAKE M 

POS/WDR#000067239301 

**3416 

: i Merch / Supp 

SAMSCLUB #6657 NOVI Mi 27300 WIXOM RD 

POS/WDR#000000038648 

**3416 : i Merch / Supp 

SAMSCLUB #6657 NOVI MI 27300 WIXOM RD 

DBT/WDR 000000036488 

**3416 : = Transportation 

SAMSCLUB #6657 NOVI MI 27300 WIXOM RD 

POS/WDR#121121349096 

**3416 : ¥ Merch / Supp 

MNRD-WIXOM WIXOM MI 

POS/RFD#121121405744 

**3416 : % Merch 

/ Supp 

$2.91 

MNRD-WIXOM WIXOM MI 

ACH/AFFIRM.COM PAYME 

AFFIRM.COM 

DEBIT ROUND UP 

ACH/MISSION LANE 

EDI PYMNTS 

EDB/WDR 000000086591 

**3416 : * Communications 

Disney PLUS Recurrin www.disneyplu FL 1375 Buena Vista Dri 

DEBIT ROUND UP 

POS/WDR#000094832529 

**3416 : % Merch / Supp 

WAL-MART #1828 FLINT Mi 4313 CORUNNA RD 

DEBIT ROUND UP 

POS/WDR#000000071201 

**3416 : i Merch 

/ Supp 

WM SUPERCENTER #1928 FLINT Mi 4313 CORUNNA RD 

DEBIT ROUND UP 

POS/WDR#121617500025 

**3416 : ® Other 

USPS PO 2532070528 FLINT Mt 

POS/WDR#121619111131 

**3416 

: 3 Merch / Supp 

WALGREENS STORE FLUSHING Ml 

POS/WDR#121619137709 

**3416 : 5 Merch 

/ Supp 

WALGREENS STORE FLUSHING MI 

ji 

DEBIT ROUND UP 

111776-064 

DBT/WDR 50000351000 

**3416 :,~ Services 

Withdrawal 

$2.00~ 

$347.00- 

$35.00- 

$30.60- 

$14.82- 

$0.18- 

$2.99 

$0.01- 

$11.00- 

$17.08- 

$29.99- 

$0.01- 

$32.22- 

$8.00- 

$11.89- 

$20.98- 

$0.79- 

$10.24 

$4.99- 

$8.43- 

$47.03- 

$1.06- 

$2.98- 

$20.50- 

$37.51 

$108.50- 

$4.26- 

$5.00- 

$12.90- 

$0.01- 

$77.88- 

$0.12- 

$77.54- 

$0.46- 

$16.46- 

$34.72- 

$41.40- 

$1.33- 

$58.97- 

Page 3 of 7 

Balance 

$953.39 

$606.39 

$571.39 

§531.79 

$516.97 

$516.79 

$513.80 

$513.79 

$502.79 

$485.71 

$455.72 

$730.67 

$730.66 

$698.44 

$690.44 

$678.45 

$657.47 

$656.68 

$646.44 

$641.45 

$633.02 

$585.99 

$584.93 

$681.95 

$561.45 

$523.94 

$526.85 

$417.35 

$413.09 

$408.09 

$395.10 

$395.08 

$317.21 

$317.09 

$239.55 

$230.09 

$222.63 

$187.91 

$146.42 

$145.09 

$86.12

FRANKENMUTH CREDIT UNION 

h 

Date 

1217/25 

12/17/25 

12/17/25 

12/18/25 

12/18/25 

12/18/25 

12/18/25 

12/18/25 

12/18/25 

12/18/25 

12/19/25 

12/19/25 

12/19/26 

12/19/25 

1219/25 

12/19/26 

12/18/25 

12/19/25 

12/20/25 

12/20/26 

12/23/25 

12/23/25 

12/24/25 

12/24/25 

12/24/25 

12/24/26 

12/24/25 

12/25/25 

12/25/25 

12/26/25 

12/26/25 

12/26/25 

12/26/25 

12127125 

12/27/25 

12/27/25 

12/27/26 

Transaction Type 

#1D 

OH" ONCOURSE ASP NAPERVILLE IL 1415 West Diehl Road 

DBT/WDR 000006504471. 

**3416 : & Merch / Supp 

GOOGLE *Google One Mountain View CA 1600 Amphitheatre Pa 

POS/RFD 40027496013 

**3416 : & Merch / Supp 

~ WM SUPERCENTER #1928 FLINT MI 4313 CORUNNA RD 

DEBIT ROUND UP 

POS/RFD#00201644077 

**3416 ; & Merch / Supp 

WALGREENS #6054 FLUSHING MI 1570 E PIERSON RD 

POS/WDR#000000851003 

**3416 : & Merch 

/ Supp 

SAMS CLUB #4944 GRAND BLANC MI 6160 S SAGINAW RD 

POS/WDR#000000844076 

**3416 

: & Merch / Supp 

SAMS CLUB #4944 GRAND BLANC MI 6160 S SAGINAW RD 

POS/WDR 121820553775 

**3416 : = Transportation 

SPEEDWAY 44487 GRAND BLANC MI 

POS/WDR#000000158440 

**3416 

: e Transportation 

SPEEDWAY 44487 GRAND BLANC MI 1435 E HILL RD 

AGH/T-MOBILE 

PCS SVC 

BOUNCE PROTECT FEE 

AVAIL BALANCE WAS $29.28 BEFORE ACH/T-MOBILE 

PC CU TRANSFER 

BOUNCE FEE 

DBT/WDR*20749429826 

**3416 

; ¢ Entertainment 

APPLE.COM/BILL CUPERTINO CA ONE APPLE PARK WAY 

PC CU TRANSFER 

COMPUTER BUY 

PC CU TRANSFER 

WALMART PC 

ACH/AFFIRM.COM PAYME 

AFFIRM.COM 

BOUNCE PROTECT FEE 

AVAIL BALANCE WAS $13.61 BEFORE ACH/AFFIRM.COM PAYME 

ACH/AFFIRM.COM PAYME 

AFFIRM.COM 

BOUNCE PROTECT FEE 

AVAIL BALANCE WAS ($81.66) BEFORE ACH/AFFIRM.COM PAYME 

POS/RFD 24606505708 

**3416 : & Merch / Supp 

EJM*BUG MD NEWPORT BEAC CA 501 Quall Street 

DBT/MLC 000000652800 

**3416 : & Merch / Supp 

WALMART.COM 80092562 BENTONVILLE AR 702 SW 8TH ST 

REV BP 

FJ 

REV BP 

FJ 

PC CU TRANSFER 

TOILET 

POS/WDR#000000682442 

**3416 

: % Merch / Supp 

SAMS CLUB #8201 FLINT MI 4373 CORUNNA RD 

POS/WDR#122418245563 

**3416 : ® Merch / Supp 

WALGREENS STORE FLINT Ml 

ACH/Dave 

DaveSubFee 

DEBIT ROUND UP 

DBT/WDR#00108535692 

**3416 

: ® Merch / Supp 

QUICK PICK PARTY STO FLINT MI 3169 W PASADENA AVE 

DEBIT ROUND UP 

DBT/WDR#00110510175 

**3416 : % Merch / Supp 

QUICK PICK PARTY STO FLINT MI 3169 W PASADENA AVE 

PC CU TRANSFER 

RODERICK L CHATMAN 

ACH/AFFIRM.COM PAYME 

AFFIRM.COM 

DEBIT ROUND UP 

ATM/DEP#000000003068 

**3416 : m Other 

DORT FINANCIAL CU FLINT MI 5091 W PIERSON RD 

ATM/WDR#000000003063 

**3416 : ® Other 

DORT FINANCIAL CU FLINT MI 5091 W PIERSON RD 

REMOTE CAPTURE 

80 

RDC AUTO-POST 

REMOTE CAPTURE 

90 

Member #: 111776 

MICHELLE R MATHIS 

Deposit 

$40.25 

$14.89 

$100.00 

$300.00 

$117.00 

$131.78 

$35.00 

$35.00 

$10.00 

$98.02 

$43.02 

$56.00 

Withdrawal 

$9.99- 

$0.04- 

$3.77- 

$29.58- 

$20.00- 

$2.11- 

$82.73- 

$35.00~ 

$46.49- 

$60.27- 

$35.00- 

$32.15- 

$35.00~ 

$414.94- 

$10.00~ 

$3.98- 

$5.82- 

$1.00- 

$0.20- 

$8.08- 

$0,92- 

$7.41- 

$23.68- 

$0.58- 

$40.00- 

Page 4 of 7 

Balance 

$76.13 

$116.38 

$116.34 

$131.23 

$127.46 

$97.88 

$77.88 

$75.77 

$-6.96 

$-41.96 

$58.04 

$11.55 

$311.55 

$428.55 

$368.28 

$333.28 

$301.13 

$266.13 

$307.91 

$-17.03 

$17.97 

$52.97 

$42.97 

$38.99 

$33.17 

$32.17 

$31.97 

$23.89 

$22.97 

$15.56 

$25.56 

$1.88 

$1.28 

$99.31 

$59.31 

$102.33 

$157.33

FRANKENMUTH CREDIT UNION 

Member #: 111776 

MICHELLE R MATHIS 

Page 5of 7 

h 

Date 

Transaction Type 

#ID 

Transfer Acct 

Deposit 

Withdrawal 

Balance 

RDC AUTO-POST 

12/28/26 

POS/RFD#122814519572 

**3416 : & Merch / Supp 

$7.41 

$164.74 

MNRD-CLIO CLIOM 

12/28/25 

POS/WDR#122815154937 

**3416 : % Merch / Supp 

$19.38- 

$146.36 

MNRD-CLIO CLIO MI 

12/28/25 

POS/WDR#000000479634 

**3416 

: @ Merch / Supp 

$6.04- 

$139.32 

SAMS CLUB #8291 FLINT MI 4373 CORUNNA RD 

12/28/25 

POS/WDR#000000494166 

**3416 : & Merch / Supp 

$7.48- 

$131.84 

SAMS CLUB #8291 FLINT MI 4373 CORUNNA RD 

. 

12/28/25 

POS/WDR#000000664043 

**3416 : 3 Merch 

/ Supp 

$48.10- 

$83.74 

WAL-MART #3445 HOLLAND OH 1355 

S MCCORD RD 

12/28/25 

DEBIT ROUND UP 

$3.00- 

$80.74 

12/29/25 

DBT/WDR#20097417480 

**3416 : & Transportation 

$8.78- 

$71.96 

LOVE S$ #0757 INSIDE MILAN MI 14137 Plank Road 

A 

12/20/25 

DBT/WDR#20100615857 

**3416 : @ Transportation 

$2.19- 

$69.77 

LOVE § #0757 INSIDE MILAN MI 14137 Plank Road 

. 

12/29/25 

DBT/WDR 01858159661 

**3416 : » Transportation 

$22.75- 

$47.02 

SAMSCLUB #8291 FLINT Mi 4373 CORUNNA ROAD 

12/29/25 

~~ ACH/SSA TREAS 310 

$1,601.00 

$1,648.02 

XXSOC SEC 

. 

12/29/25 

EARLY POSTING FEE 

$20,00- 

$1,628.02 

12/20/25 

PC CU TRANSFER 

$100.00- 

$1,528.02 

FOOD TOILET PAPER NEW YEAR 

12/29/25 

~~ ACHICOMCAST-XFINITY 

$14.95- 

$1,513.07 

CABLE SVCS 

12/29/26 

~~ ACH/AFFIRM.COM PAYME 

$54.25 

$1,458.82 

AFFIRM.COM 

12/20/25 

DEBIT ROUND UP 

$1.28- 

$1,457.54 

12/30/25 

~~ POS/WDR#123020200045 

**3416 : 

Merch / Supp 

$56.64- 

$1,401.90 

KROGER #419 FLUSHING MI 

12/30/25 

DEBIT ROUND UP 

R 

$0.36- 

$1,401.54 

12/31/25 

POS/WDR#123111016548 

**3416 : & Merch 

/ Supp 

$11.56- 

$1,389.98 

} 

TARGET T-0872 Livonia Ml 

12/31/26 

SECURITIES DEPOSIT 

$0.06 

$1,390.04 

DIVIDEND DISTRIBUTION FROM VOO 

. 

12/31/25 

DBT/WDR*50001003663 

**3416 : $k Merch / Supp 

$4.99- 

$1,385,056 

. 

RING BASIC PLAN HAWTHORNE CA 12515 Cerise Ave 

12/31/25 

POS/WDR#536503913563 

**3416 

: *& Merch / Supp 

$24.27- 

$1,360.78 

COSTCO WHSE #03 LIVONIA MI 

12/31/25 

DEBIT ROUND UP 

111776-064 

$1.18- 

$1,350.60 

12/31/25 

 ** Ending Balance ** 

$2,866.63" 

$2,834,28* 

$1,359.60 

Total NSF FEE summary this period: 

.00 

Total Year-to-Date: 

.00 

Total BOUNCE PROTECT FEE summary this period: 

105.00 

Total Year-to-Date: 

245.00 

LOAN ACCOUNTS 

645; SIGN LN -SECURE 

Annual Percentage Rate: 

14.390 % 

Rate In effect until: 

Daily Periodic Rate: 

Transaction.0394246 % 

Due Date: 

12/30/25 

Scheduled Pay Amt: 

$194.53 

Detail 

Date 

Transaction Type 

#ID 

Transfer Acct 

Disbursement 

Payment 

Balance 

Interest 

12/01/25 

 * Beginning Balance * 

$3,394.47 

12/05/25 

INT DUE FOR SKIP 645 

BF 

[ 

$39.60 

$3,394.47 

$39.60 

12/31/25 

 ** Ending Balance ** 

$3,394.47 

Total Interest Paid This Period: 

$39.60 

Total Interest Paid Year-to-Date: 

$600.94 

ANNU 

CCOUNT INFORMATION FOR 2025 

his section is intended to provide a general summary of your dividend and Interest activity for the year, and is not intended fo replace any standard IRS 

forms you receive for tax reporting purposes,

FRANKENMUTH CREDIT UNION 

Member #: 111776 

MICHELLE R MATHIS 

Page 6 of 7 

B| LOAN INTEREST PAID IN 2025 

ACCOUNT ne 

SIGNATURE LOAN 

$600.94 

Total Interest Paid for 2025: 

$600.94 

DIVIDENDS EARNED IN 2025 

Total Dividends Earned for 2025: 

$9.29 

KASASA CSHBK SAVER 

$9.29 

Disclosures 

Loan number(s) followed by an asterisk (*) are open end credit accounts. With regard to those accounts, the balance subject to interest rate (shown in 

the "Bafance” column) is the unpaid balance each day after credits are subtracted and ihe new advances or charges are added. The Finance Charge Is 

computed on the daily outstanding balance by applying the daily periodic rate to the balance for the exact number of days such balence remains 

outstanding. The outstanding balance is shown in the columns marked balance and the daily periodic rate is disclosed after the account number. The 

ANNUAL PERCENTAGE RATE, which is determined by multiplying the Daily Periodic Rate by the number of periods in the year (365), Is llkewise 

disclosed after the account number. 

’ 

Your savings are federally insured to atleast $250,000 and backed by the full faith and credit 

of the United States Govemment.

FRANKENMUTH CREDIT UNION 

Member #: | 

EE RMATHIS 

Page 7 of 7 

| FORM 

109 

THIS IS YOUR FORM 1092-INT. YOU WILL NOT RECEIVE A SEPARATE FORM 1089-INT IN THE MAIL. 

ALL [RA ACTIVITY AND LOAN INTEREST WILL BE REPORTED ON 

STANDARD IRS FORMS AND WILL BE SENT IN A SEPARATE MAILING. 

PAYER'S name, street address, city or town, province or state, country, 

ZIP or foreign postal code, and telephone no, 

a 

FRANKENMUTH CREDIT UNION 

2025 

Interest Income 

Cory 

580 N MAIN ST 

Form 1099-INT 

OMB No. a 

For Recipient 

PO BOX 209 

This Is important tax information and is 

being furnished to 

FRANKENMUTH, MI 48734-0000 

the Internal Revenue Service. If you are required fo file a 

return, a negligence penalty or other sanction may be 

989-497-1600 

imposed on you if this income is taxable and the IRS 

determines that it has not been reported, Please retain this 

form for your records. 

7 

—— 

See 1099-INT Instructions for Recipient on an enclosed 

PAYER'S federal Identification 

RECIPIENT'S identification number] form. 

number 

3003 

1 Interest Income not included in Bo: 

2 Early withdrawal 

3 Interest on U.S, Savings Bonds and Treas, 

4 Federal income tax 

3 

penalty 

obligations 

withheld 

$9.29 

$.00 

$.00 

3.00

tor 

PERIOD ENDING 

. 

: 

RECONCILEMENT OF CHECK ACCOUNT 

) 

CHECKS OUTSTANDING 

TO RECONCILE YOUR ACCOUNT 

CHECK NO. 

AMOUNT 

1. 

ENTER YOUR NEW BALANCE SHOWN ON THIS STATEMENT. 

ADD 

2. MATCH DEPOSITS MADE WITH DEPOSITS SHOWN ON THIS 

STATEMENT, FIND THE TOTAL OF ANY DEPOSITS MADE AND 

3 

NOT SHOWN ON THIS STATEMENT. 

SUBTOTAL 

 § 

3. GO THROUGH YOUR CHECK COPIES OR CHECK REGISTER 

SUBTRACT 

AND MARK OFF EACH CHECK THAT IS SHOWN AS PAID ON 

THIS STATEMENT. 

ENTER ALL UNPAID CHECKS IN THE 

CHECKS OUTSTANDING COLUMN AND ADD THEM. SUBTRACT 

 § 

THE TOTAL OF THE OUTSTANDING CHECKS, 

ADJUSTED STATEMENT 

BALANCE 

$ 

4. 

SHOW YOUR END OF PERIOD CHECKBOOK BALANCE. 

$ 

5. GHECK YOUR STATEMENT FOR THE DIVIDEND INTEREST AND 

ADD 

OTHER SPECIAL ADDITIONS TO YOUR ACCOUNT; IF ANY, ADD 

THESE TO YOUR CHECKBOOK BALANCE IF YOU HAVE NOT AL- 

READY DONE SO. 

8. 

SUBTOTAL 

 § 

6. IF ANY SPECIAL CHARGES (SUBTRACTIONS) ARE SHOWN ON 

SUBTRACT 

YOUR STATEMENT (CHARGES FOR A NEW SUPPLY OF 

CHECKS, FOR STOP PAYMENT, FOR OVERDRAFT, FOR PREAL- 

THORIZED PAYMENT, ETC.), DEDUCT THESE CHARGES IF YOU 

HAVE NOT ALREADY DONE SO, 

$, 

ADJUSTED STATEMENT 

BALANCE 

$. 

IF YOU DO NOT BALANCE 

1. 

Verify additions and subtractions both here and in your check register or on 

your check copies. 

2. 

Compare the check dollar amount shown on your statement with the amounts 

shown on your check copies or in your check register. 

3. 

Compare deposits shown on the statement with deposits recorded on your 

TOTAL 

check copies or in your register. 

7 

A. THE FOLLOWING IS APPLICABLE ONLY TO AN OPEN-END LOAN ACCOUNT. AN OPEN-END LOAN ACCOUNT IS IDENTIFIABLE BY AN 

ASTERISK (*) PRINTED AFTER THE ACCOUNT SUFFIX(ES) IN THE LOAN ACCOUNTS SECTION OF THIS STATEMENT. 

In Case of Errors or Questions About Your Statement 

If you think your statement Is wrang, or if you need more information about a transaction on your statement, write us (on a separate sheet) at the address shown on 

the first page of this statement as soon as possible. We must hear from you no later than 60 days after we sent you the FIRST statement on which the error or 

problem appeared. You can telephone us, but doing sa will not preserve your rights, 

In your letfer, give us the following information: 

= Your name and account number. 

* The dollar amount of the suspected error. 

* Describe the error and explain, If you can, why you believe there Is an error. 

If you need more information, describe the item you are unsure about. 

You do not have to pay any amount in question while we are investigating, but you are still obligated to pay the parts of your statement that are not in question. 

While we investigate your question, we cannot report you as delinquent or take any action to collect the amount you question. 

Special Rule for Credit Card Purchases 

If you have a problem with the quality of goods or services that you purchased with a credit card, and you have tried in good faith to correct the problem with the 

merchant, you may not have to pay the remaining amount due on the goods or services. You have this protection only when the purchase price was more than 

$50 and the purchase was made in your home state or within 100 miles of your malling address. 

{If we own or operate the merchant, or if we mailed you the 

advertisement for the property or service, all purchases are covered regardless of amount or location of purchase.) 

Nor 

THE FOLLOWING PROCEDURE IS APPLICABLE ONLY TO YOUR ELECTRONIC FUNDS TRANSFERS. 

In Case of Errors or Questions About Your Electronic Transfers * 

Telephone or write us at the address or phone number shown on the first page of this statement as soon as you can if you think your statement or receipt Is wrong 

or if you need more information about a transfer listed on the statement, We must hear from you no later than 60 days after we Send you the FIRST statement on 

which the problem or error appeared. 

1, 

Tell us your name and account number (if any). 

2. Describe the error or the transfer you are unsure about, and explain as clearly as you can why you belleve it is an error or why you need more Information. 

3. Tellus the dollar amount of the suspected error. 

If you tell us orally, we may require that you send us your complaint or question in writing within ten (10) business days. 

We will tell your the results of our investigation within ten (10) business days after we hear from you and will correct any error promptly. 

If we need more time, 

however, we may take up to 45 business days*” to investigate your complaint or question. 

If we decide to do this, we will credit your account within ten (10) 

business days*** for the amount you think is in error, so that you have use of the money during the time it takes us to complete our investigation, 

If we ask you to 

put your complaint or question in writing and we do not receive it within the ten (10) business days, we may not credit your account. 

If we decide that there was no error, we will send you a written explanation within three business days after we finish our investigation. You may ask for copies of 

the documents that we used in our investigations. 

* This error correction procedure does not apply to business accounts or to business transactions performed via your account. 

Trust accounts and custodial 

accounts ars exempt from this procedure in some states. 

** If you give notice of an error within 30 days after you make your first deposit to your account involving a point of sale transaction, or notice of error involving a 

transaction initiated outside the United States, its possessions and territories, we will have 90 days instead of 45 days to perform our investigation, 

*** If you give notice of an error within 30 days after yout make your first deposit to your account, we will have 20 business days instead of 10 business days to credit your account.

._-2026 BOARD OF REVIEW DECISION ~~~ ~~ 

FROM 

MT MORRIS CHARTER TOWNSHIP 

h! 

5447 BICENTENNIAL DR 

MT MORRIS, MI 48458 

NAME AND ADDRESS OF OWNER OR PERSON NAMED ON ASSESSMENT ROLL: 

PROPERTY IDENTIFICATION: (Parcel Code required. Property address 

and legal description optional.): 

14-34-577-109 

3065 ROANOKE ST 

MATHIS, MICHELLE 

3065 ROANOKE ST 

FLINT, MI 48504 

LOTS 196 197 & 198 WASHINGTON PARK. SUB (74) 

THIS PROPERTY IS CLASSIFIED 

401 (RESIDENTIAL-IMPROVED) 

Thank you for attending this years March Board of Review. The Board has reviewed the information you supplied and the data necessary 

to compute your assessment and taxable value. 

The Board has completed their review of parcel number 

14-34-577-109 

They have made the following determination based on the information you supplied. 

Board of Review Comments 

POVERTY EXEMPTION DENIED EXCEEDS INCOME LIMITS 

2026 ORIGINAL ASSESSED VALUE 

25,600 

| 

2026 +0iD OF REVIEW" ASSESSED VALUE 

25,600 

(If the above amounts are the same, no revisions have occured) 

2026 ORIGINAL TAXABLE VALUE 

15,023 

2026 "BOARD OF REVIEW" TAXABLE VALUE 

15,023 

2026 PRINCIPAL RESIDENCE EXEMPTION/QUALIFIED AG 

100.0000 

’lease feel free to contact the assessor at the address listed above or call if you have any questions. 

‘Effective March 1, 2013, the Tribunal is no longer able to accept Small Claims letter appeals. Rather, you are required to file a petition to 

nitiate a new Small Claims appeal. Petition forms are available on this website," 

1ttp://www.michigan.gov/taxtrib/0,4677,7-187-3 8254---,00.html

STATE OF MICHIGAN 

DEPARTMENT OF LICENSING & REGULATORY AFFAIRS 

MICHIGAN ADMINISTRATIVE HEARING SYSTEMS 

MICHIGAN TAX TRIBUNAL 

Michelle R. Mathis, 

Petitioner, 

MOAHR Docket No. 26-000684 

V. 

Township of Mt. Morris, 

Respondent, 

Michelle R. Mathis 

Linda Spearling, Assessor 

3065 Roanoke St. 

Mt. Morris Township 

Flint, MI 48504 

5447 Bicentennial Dr 

(810)874-6111 

Mt. Morris, MI 48458 

(810) 785-1054 x204 

PROOF OF SERVICE 

The undersigned certifies that she served a copy of the Answer and 

a 

copy of this proof of service on petitioner by first class mail with postage fully paid 

thereon to the address above on July 07, 2026. 

Spee 

Cinda Spearling, Assessor

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