Fillable Support Credit Form printable pdf download

STATE OF MICHIGAN

DOCKET NO.

SUPPORT CREDIT FORM

JUDICIAL CIRCUIT

JACKSON COUNTY

Jackson County Friend of the Court (FOC), 1697 Lansing Avenue, Jackson, MI 49202

Telephone: 517-788-4470

Fax: 517-788-4683

Website:

Name of Payer of Support: ____________________________________ Date: _____________________________

Name of Payee of Support: _____________________________________ Payee Phone No.:____________________

PLEASE BE ADVISED THAT A PAYEE CANNOT REQUEST A SUPPORT CREDIT TOWARDS ARREARAGES OWED

TO THE STATE OF MICHIGAN OR ANOTHER AGENCY. ONCE A CREDIT IS PROCESSED, IT CANNOT BE

REVOKED WITHOUT A COURT ORDER.

Did the payer give you cash, a money order, or a check outside of the FOC? YES

If YES fill out section 1, if NO please skip to section 2

SECTION 1:

Direct Payment Credit

[Complete if you answered YES to the question above.]

A direct payment credit is for a cash payment, money order, or check made outside of the Michigan State Disbursement

Unit (MISDU) or FOC. Excessive requests for direct payment credits are subject to additional review as the support

payer was ordered to pay support through the MISDU or FOC. If your file is identified for excessive direct payment

credits, you will receive written notice to discontinue direct payments or such payments may be considered as gifts.

By signing below, I am consenting to credit the payer’s support arrearages for a cash payment paid

directly to me in the amount of $_______________ on ______/______/______. Also, I am spelling

out the amount of the cash payment in written form below:

_________________________________________________________________________

(Example: $100.00 credit in written form is, one hundred dollars)

[

SECTION 2:

Arrearage Write Off

Complete if you answered NO to the question above.]

An arrearage is a buildup of past due support payments that were not paid by the payer in the manner that was ordered by

the Court. A payee may forgive arrearages owed to them in full or in part.

I am giving my signed consent to cancel all past due arrearages owed to me.

I am giving my signed consent to cancel some of the past due arrearages owed to me in the amount of

$________________. I am also spelling out the amount of the arrearage I am cancelling:

_____________________________________________________________________________

(Example: $100.00 credit in written form is, one hundred dollars)

By signing this document in front of a Notary Public, I am giving my consent to credit the payer’s account as stated

above. I also certify that I have not been coerced, manipulated or forced into signing this form. I also acknowledge

my understanding that this credit, once processed, cannot be revoked without a court order.

Payee Signature: ____________________________________

Subscribed and sworn before me on this

day of

Notary Public, Jackson County, MI

My Commission Expires:______________

Support credit form revised [May 25, 2016]

Support Credit Form

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