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13. Signature of Person Requesting Hearing AH must receive an original signature. If this form is signed by an authorized hearing representative documentation of authorization must be attached. 16. Street Address or Route Number 17. City State and Zip Code 18. Are special arrangements required for you to participate in a hearing Yes 15. REQUEST FOR HEARING 1. Case Name Last State of Michigan Department of Human Services First 2. Address 3. A date-stamped copy will be returned to you by the loca ...

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