Dear Click or tap here to enter text. This letter is to acknowledge receipt of your grievance on (date) regarding services you received from (name provider).Michigan Legal Help has tools to fill many kinds of forms but we do not cover all areas. You may have a blank form that you need to fill out on your own. Note: you can't sue a federal agency in small claims. The purpose of this referral is to recognize EMS personnel who provided exemplary patient care, going above and beyond standard care in a particular incident. When preparing a complaint, enter all of the information that is requested on the form in the spaces provided. Sign and date the completed paper form. Despite examples of successful supported housing in the County, Defendants. Thank you for your question.