STATE OF MICHIGAN

GRETCHEN WHITMER GOVERNOR

STATE OF MICHIGAN DEPARTMENT OF LICENSING AND REGULATORY AFFAIRS

LANSING

ORLENE HAWKS DIRECTOR

_____________________________, Petitioner(s)

MICHIGAN TAX TRIBUNAL

v

MOAHR Docket No.

_____________________________, Respondent(s)

PROOF OF SERVICE

___________________________________ states that on ___________________ he/she

[Name of person serving/mailing petition]

[date of service]

served a copy of the ___________________ relative to the above-captioned matter upon:

[Provide name and address of the party/people being served]

________________________________________________

________________________________________________

________________________________________________

________________________________________________

_________________________________________ [Signature of person who is serving/mailing copy]

_________________________________________ [Print/type name of person serving/mailing copy]

MICHIGAN OFFICE OF ADMINISTRATIVE HEARINGS AND RULES MICHIGAN TAX TRIBUNAL

611 W. OTTAWA ST ? P.O. BOX 30232 ? LANSING, MICHIGAN 48909-8195 ? 517-335-9760

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