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PDF-Michigan Department of Treasury4926 Rev 1114Electronic Funds Trans PDF document

Tax TypeHealth Insurance Claims Assessment Quarterly Payment Health Insurance Claims Assessment Annual Payment Tax Type CodeEFT DEBIT OR CREDIT AUTHORIZATIONPlease

treasury x00660069 insurance michigan x00660069 treasury michigan insurance assessment claims account eft form department health electronic application cer funds

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Michigan Department of Treasury4926 Rev 1114Electronic Funds Trans: Transcript

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