State Land Bank Authority

State of Michigan

Official Website: https://www.michigan.gov/leo/bureaus-agencies/landbank

Forms & Documents

Browse all State Land Bank Authority government forms

1 - 20 of 36 forms

Form Title Topics
AGREEMENT TO REDEEM LIABILITY
AMPUTATION CHART
APPLICATION FOR ADVANCE PAYMENT
APPLICATION FOR AGENCY APPROVAL AS A REHABILITATION FACILITY
APPLICATION FOR AUTHORIZATION BY SELF-INSURED EMPLOYER OR GROUP FUND FOR SERVICING AGENT FTS USER ACCOUNT
APPLICATION FOR CERTIFICATION OF A CARRIER’S PROFESSIONAL HEALTH CARE REVIEW PROGRAM
APPLICATION FOR CHRISTOPHER R. SLEZAK FIRST RESPONDER PRESUMED COVERAGE FUND
APPLICATION FOR FTS USER ACCOUNT­WC Claims Mailbox
APPLICATION FOR MEDIATION OR HEARING – FORM B
APPLICATION FOR MEDIATION OR HEARING — FORM C
APPLICATION FOR REIMBURSEMENT FROM THE MEDICAL BENEFITS FUND
AUTHORIZATION TO DISCLOSE CONFIDENTIAL WORKERS’ COMPENSATION INFORMATION
Carrier’s Explanation of Benefits
CLAIM/CROSS-CLAIM FOR REVIEW
EMPLOYEE’S REPORT OF CLAIM
EMPLOYER DISCLOSURE QUESTIONNAIRE
Health Insurance Claim Form
MEDICARE-MEDICAID-FRIEND OF THE COURT Addendum to Agreement to Redeem Liability
MICHIGAN CERTIFICATE OF SPECIFIC/AGGREGATE EXCESS LIABILITY INSURANCE
MICHIGAN CONTINUOUS SURETY BOND

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