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Get Recipient Rights Complaint Form - State Of Michigan - Michigan

When report is ready please call me at Telephone Mail to me at the following address by registered mail Street Address City State Zip Code Recipient s signature Sign Page 2 also Printed Name Date Give this form to your rights advisor Date Received by rights advisor Date Report due to recipient Copies To Recipient MDCH/BHS/L C/SALS Coordinating Agency Rights Advisor s Signature BHS-LC-901 Revised 04/04 By Authority PA 368 of 1978 as amended Page .

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