TRIAL MEMBERSHIP APPLICATION - 2021



     
  
  


           
  
* Include here your TOTAL from all sources of funds including monies generated from non-levy sources (federal dollars, etc.).
  

     

** Include here the actual tax rate at which your board is levying during the current fiscal year.
Name Address Occupation  


Name Position/Title  
NAME of Agency or Program MI DD SUD OTHER
Mark @mdo @mdo @mdo @mdo
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