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T, MI 48232-0112 Part I Filing Information 1 Indicate the type of filing by checking a, b, c, or d (check only one) a Initial designation b Biennial renewal 2 Effective date of the exemption Exemption amended d Exemption revoked / / MM Part II c DD YYYY Exempt Person Information 4 Doing business as (DBA) 3 Legal name of the exempt person 5 Address 7 State 6 City F *9 EIN or SSN 8 ZIP Code 10 Type of exempt person, check box a, b, c, d, e, or.

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