Form Foc 109 - Motion Regarding Payment Plan/discharge Of Arrears Page 7
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8Original - Court
3rd copy - Friend of the court
1st copy - Other party
4th copy - Proof of service
Approved, SCAO
2nd copy - Moving party
5th copy - Proof of service
A
STATE OF MICHIGAN
CASE NO.
MOTION REGARDING PAYMENT PLAN/
JUDICIAL CIRCUIT
DISCHARGE OF ARREARS
COUNTY
Court address
Court telephone no.
B
Plaintiff’s name, address, and telephone no.
moving party
Defendant’s name, address, and telephone no.
moving party
v
Third party name, address, and telephone no.
moving party
C
1. Friend of the court records show that, as of
:
Date
a. my current support is $
per month. My youngest child in the case will be or was 18 years of age on
.
Date
b. my total arrears are $
.
Attached is written proof from the friend of the court office.
c. I owe $
support arrears to
, the individual payee.
Name
d. I owe $
support arrears to the State of Michigan.
e. I owe $
for Medicaid/confinement reimbursement arrears.
f. I owe $
in statutory fees.
g. I owe $
to
.
Specify agency/person
2. It is in the best interests of the parties and the child(ren) that a payment plan be ordered in this case.
D
3. I understand that the individual payee must consent to entry of an order for payment plan when the arrears are owed
to that individual. The payee’s consent was not given under fear, coercion, or duress.
E
4. I owe arrears to the State of Michigan or a political subdivision and, absent a payment plan, I do not have the present
ability and will not have the ability in the foreseeable future to pay the arrears.
5. I did not engage in conduct exclusively for the purpose of avoiding my support obligation.
F
6. I have gross income in the amount of $
per
. I understand that I must provide adequate records
to show proof of my income.
G
7. I have assests, solely or jointly owned, as of this date, as follows: (assests include but are not limited to vehicles, real
estate, bank accounts, retirement accounts, trust funds, etc.)
Continue on page 2 and attach a separate sheet if more space is needed.
Description
Net Value
a.
$
b.
$
c.
$
(See page 2 for remainder of motion.)
MOTION REGARDING PAYMENT PLAN/DISCHARGE OF ARREARS
FOC 109 (6/17)
MCL 552.605e
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