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PLC:

a004ov

Agency:

columbia township

For:

tax

Phone:

269-434-6227 x2

Address:

p o box 133
grand junction, michigan 49056

*Required Field

Payment Information

*Taxpayer Name:

Middle:

*Last:

*Property Address:

*City:

*State:

*Zip:

*Tax ID # Example: 80-06-000-000-00:

*Phone #:

(### - ### - ####)

Payment Amount

*Payment Type:

Payment Amount :

Subtotal:

$0.00

Total:

$0.00

Billing Information

*First Name:

Middle Initial:

*Last Name:

*Billing Address:

*City:

*State/Province:

*Zip:

*Country:

*Phone Number:

*Credit/Debit Card:

(enter the full card number without any dashes or spaces)

*Expiration Date:

*Card Security Number:

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