Form Foc 10a / 52a - Uniform Child Support Order - Michigan Judicial Circuit County
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1
2
3Original - Court
2nd copy - Defendant
Approved, SCAO
1st copy - Plaintiff
3rd copy - Friend of the court
STATE OF MICHIGAN
CASE NO.
UNIFORM CHILD SUPPORT ORDER,
JUDICIAL CIRCUIT
NO FRIEND OF COURT SERVICES (PAGE 1)
COUNTY
EX PARTE
TEMPORARY
MODIFICATION
FINAL
Court address
Court telephone no.
Defendant's name, address, and telephone no.
Plaintiff's name, address, and telephone no.
v
Plaintiff's attorney name, bar no., address, and telephone no.
Defendant's attorney name, bar no., address, and telephone no.
Defendant's source of income name, address, and telephone no.
Plaintiff's source of income name, address, and telephone no.
This order is entered
after hearing.
on stipulation/consent of the parties.
An order exempting this case from friend of the court services was entered on
.
(NOTE: If there is no order exempting this case from friend of the court services, form FOC 10/52 must be used.)
IT IS ORDERED, unless otherwise ordered in item 8 or 9:
Standard provisions have been modified (see item 8 or 9).
1. The children who are supported under this order and the payer and payee are:
Payer:
Payee:
Children's names, birthdates, and annual overnights with payer:
Children's names
Date of birth
Overnights
Effective
, the payer shall pay a monthly child support obligation for the children named above.
Children supported:
1 child
2 children
3 children
4 children
5 or more children
Base support: (includes support plus or minus premium adjustment for health-care insurance)
Support:
$
$
$
$
$
Premium adjust. $
$
$
$
$
Subtotal:
$
$
$
$
$
Ordinary medical: $
$
$
$
$
Child care:
$
$
$
$
$
Other:
$
$
$
$
$
Benefit credit:
$
$
$
$
$
Total:
$
$
$
$
$
Support was reduced because payer's income was reduced.
(Continued on page 2.)
MCL 552.14, MCL 552.517, MCL 552.517b(3),
UNIFORM CHILD SUPPORT ORDER, NO FRIEND OF COURT SERVICES, PAGE 1
MCR 3.211
FOC 10a / 52a (11/16)
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