Rule 5.
STATE OF MICHIGAN DEPARTMENT OF REVENUE
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________________________________________ Appellant vs. DOCKET NO.
City of ________________________________ Appellee
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PETITION
TO THE STATE COMMISSIONER OF REVENUE:
The above-named appellant hereby petitions for a redetermination of the (final assessment, denial in whole or part of a claim for refund, special ruling, adoption of a rule or regulation by the administrator) set forth by the City of ________ in its determination, decision or order dated ______ , 19 ______ and as a basis of his proceeding alleges as follows:
(Street) (City) (State)
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(Here set forth allegations of facts relied upon, the prior legal steps taken by the petitioner, in orderly and logical sequence, with subparagraphs lettered, so as to inform the commissioner of revenue of the issues to be presented and to enable the city to admit or deny each specific allegation.) Wherefore, the appellant prays that the commissioner of revenue may hear the proceedings and (state the relief desired). Signed ___________________________ Appellant
___________________________ Address
State of ____________________________________
County of _________________________________
_________________________ , being duly sworn, says that he is the petitioner (if a corporation, or fiduciary, state title of office or trust of person verifying and that he is duly authorized to verify the foregoing petition) above named; that he has read the foregoing petition, or had the same read to him, and is familiar with the statements contained therein, and that the statements contained therein are true, except those stated to be upon information and belief, and that those he believes to be true.
Signed ____________________________
Subscribed and sworn to before me this ________ day of ___________ , 19____
Signed __________________________________
(Official title)
(Seal)
Mich. Admin. Code R. 205.905