KEWEENAW BAY INDIAN COMMUNITY
Senior Tax Reimbursement Program
Printed Name: _________________________________________________
Address: _________________________________________________
_________________________________________________
Enrollment No.: __________
Date of Birth: _____ / _____ / ______
I am requesting reimbursement for my 2020 tax preparation.
2020 Tax Prep Home Heating Credit
Who prepared your taxes? __________________________________________
Amount of Request: ______________________
Signature: ___________________________________ Date: _____________
Please allow 12-15 business days for reimbursement to be processed.
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