Blue Cross and Blue Shield of Michigan 04-408 - State of Michigan - michigan 2025

1. Click ‘Get Form’ to open it in the editor.
2. Begin by filling in the petitioner’s name at the top of the form. Ensure that all names are spelled correctly to avoid any processing issues.
3. In the case number section, enter '04-408-BC' as indicated. This is crucial for tracking your case.
4. Next, provide the respondent's details, including their name and address. Double-check for accuracy.
5. Complete the certificate of service section by entering the date when you served copies of the final decision. This is important for legal documentation.
6. Finally, ensure that all signatures are added where required, including those of witnesses or notaries if applicable.

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