Fillable Cass County Friend of the Court (Cass County Michigan Courts)

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Cass County Friend of the Court (Cass County Michigan Courts)

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Stipulation to Modify Custody, PT, and CS (04/19)
Cass County Friend of the Court
Law & Courts Building, 60296 M62 Suite 3
Cassopolis, Michigan 49031
Phone: (269) 445-4436
Fax: (269) 445-4435
INSTRUCTIONS FOR STIPULATION AND ORDER MODIFYING
CUSTODY, PARENTING TIME AND SUPPORT
These forms are to be used to ask the Circuit Court to establish or change custody and
parenting time orders. Carefully read all instructions before starting to fill out the forms.
Complete the Stipulation form by following the instructions in the order they are listed.
Please type or print clearly on all forms.
Using the other court papers from your case with the other parent:
(A) Locate the Case Number (sometimes called File # or Docket #) and put it in the
Stipulation and Order forms in area (A).
(B) Look to see who is the Plaintiff and who is the Defendant. Copy the names where
the forms are labeled (B). Below the names, insert the current address for each person
below his or her name. If known, insert the phone numbers for the Plaintiff and the
Defendant after each address.
(C) Carefully read your judgment or order to find out if there is an order regarding
custody or parenting time. If no order has been entered about these things, then check
the first box at (C). If there is a custody and/or parenting time order, then check the
second box at (C), and fill in the date of the most recent order regarding custody or
parenting time.
(D) Check the appropriate box showing who has physical custody of the children under
the most recent order.
(E) Check the appropriate box showing who is required to pay child support for the
children under the most recent order.
(F) Insert the names and dates of birth of the children as indicated.
(G) Check the box that best describes the LEGAL custody agreement you both have
reached
(H) Check the box that best describes the PHYSICAL custody agreement you both have
reached. (If you have chosen Joint Physical Custody then you MUST complete attachment 1 or
your Stipulation will not be approved).
(I) Check the box that best describes the parenting time (visitation) agreement you both
have reached. If you have agreed to specific times during which parenting time will
Stipulation to Modify Custody, PT, and CS (04/19)
occur, attach a separate sheet of paper to the Stipulation stating exactly what you have
agreed.
(J) Fill in the blank indicating the state in which the children will live.
(K) Check the box indicating which parent has the right to claim the children for tax
purposes. If neither box is checked, the usual IRS rules will apply.
(L) The application of the Michigan Child Support Formula to set the child amount is
mandatory, except in very limited circumstances. Upon entry of the order based upon
this stipulated agreement, the Friend of the Court shall commence a child support
review and issue a recommendation as to the amount of child support. Unless a party
objects to the recommendation and requests a hearing, the recommendation shall
become the order of the court, effective the date the order approving this stipulated
agreement was entered.
(M) Fill in the medical insurance information for both parents. If there is no coverage,
put none in the appropriate spaces.
(N) & (O) You must now appear in the presence of a Notary Public and date to sign the
Stipulation. DO NOT sign this Stipulation BEFORE or UNTIL you are in the presence of
a Notary. Your bank or insurance agent will usually have a Notary Public willing to assist
you. The other parent must also appear in the presence of a Notary Public and date
and sign the Stipulation. The other parent must NOT sign the Stipulation BEFORE or
UNTIL they are in the presence of a Notary.
Take or mail the original Stipulation and Order to the Cass County Friend of the Court
office at the Law & Courts Building, 60296 M-62 Suite 3, Cassopolis, Michigan, 49031,
and ask for your Stipulation to be “approved and entered”.
The Friend of the Court will review your Stipulation for completeness and further prepare
your Stipulation and Order for consideration by the Judge. A hearing will need to be
scheduled at which time both parties will need to appear and testimony will need to be
taken by the Court so that the Court can make a finding that your Stipulation is in the
“best interests” of your child(ren).
NOTE: IF YOU ARE CHANGING CUSTODY, BOTH PARTIES MUST TURN IN
RECENT PAYSTUBS, PROOF OF BENEFITS, AND OTHER VERIFICATION OF ALL OF
YOUR CURRENT INCOME.
Although you will not be charged for the stipulation, if you have outstanding fees
and/or costs you will be required to pay those fees or costs before the stipulation will
be entered.
Stipulation to Modify Custody, PT, and CS (04/19)
STATE OF MICHIGAN
IN THE CIRCUIT COURT FOR THE COUNTY OF CASS
FAMILY DIVISION
(A) (B)
______________________________,
____________________________
Plaintiff,
File No.
vs.
Hon. SUSAN L. DOBRICH (P32783)
Family Court Judge
______________________________,
Defendant
STIPULATION TO MODIFY CUSTODY, PARENTING TIME
AND CHILD SUPPORT
(C) There is currently no order regarding custody.
On __________________, a judgment or order was entered regarding custody:
(D) Mother Father Both parties A third party currently has physical custody
of the minor children.
(E) Mother Father Both parties are currently paying support for the children.
(F) NAMES AND DATES OF BIRTH OF MINOR CHILDREN
(add additional sheet if necessary)
The minor child or children of the parties to this action, and the date(s) of birth are as follows:
__________________________, DOB ___________________
__________________________, DOB ___________________
__________________________, DOB ___________________
__________________________, DOB ___________________
The other parent and I have agreed that custody, parenting time, child support, and
domicile shall be changed as follows:
Stipulation to Modify Custody, PT, and CS (04/19)
(G) LEGAL CUSTODY OF MINOR CHILD(REN)
(If you check more than 1 box in the Legal Custody section, your order will not be approved by the Court)
Legal custody of the minor child(ren) born of this marriage is awarded:
Jointly to both parties.
Only to Plaintiff.
Only to Defendant.
until the child(ren) is/are 18 years old, or until further order of the Court.
If joint legal custody is awarded it means:
a. Both parents will enjoy equal and shared authority with the other parent with respect to
“major decisions” affecting a child, including, but not limited to: education, religion,
enrichment activities, or health/medical needs.
b. Everyday routine decisions shall be made by the parent with whom a child is with at that
time.
c. Each parent will consult with the other parent, and make a good faith effort to reach an
agreement before making “major decisions” such as those in paragraph “a” affecting a child.
d. If a dispute develops concerning the co-parenting of the child(ren), and the parents cannot
reach a mutual agreement, or if one parent believes the other is not following this joint
custody order, they will jointly seek the advice of a mutually agreed upon third party to
mediate the dispute. They will not resort to a court petition without first taking this step. [To
avoid future problems, the parents may list at least one person, counselor, or agency that
they find acceptable to mediate any disputes that might arise.
THE COURT RESERVES THE RIGHT TO TAX COSTS AND ATTORNEY FEES AGAINST
A PARENT WHO FRUSTRATES THESE PROVISIONS, THEREBY NECESSITATING A
COURT MOTION HEARING.
e. Each parent will timely keep the other parent advised of any and all illness, emergencies,
or other significant occurrences that develop while a child/the children is/are with them.
f. Each parent will timely inform the other parent of all routine medical, dental, optical and
psychological treatments for a child/the children, and give opportunity to be present.
g. Each parent will timely inform each other parent of school, music, sports, fine arts, or other
enrichment activities of a child/the children, so as to allow an opportunity for attendance and
involvement.
h. As required by law, both parents will facilitate complete and unobstructed access to all
records pertaining to the development of a child/the children, including medical and school
records.
Stipulation to Modify Custody, PT, and CS (04/19)
(H) PHYSICAL CUSTODY OF MINOR CHILD(REN)
(If you check more than 1 box in the Physical Custody section, or have failed to complete
the checked section completely, your order will not be approved by the Court)
Sole Physical Custody.
The Plaintiff Defendant shall have physical custody of the minor child(ren) until the
child(ren) is/are 18 years old, or until further Order of the Court subject to the other party’s
parenting time schedule set forth below.
Joint Physical Custody.
The Plaintiff and Defendant shall have joint physical custody of the minor child(ren) until the
child(ren) is/are 18 years old, or until further Order of the Court according to the parenting
time schedule set forth below.
Split Physical Custody.
The Plaintiff shall have physical custody of the following minor child(ren):
__________________________________, DOB ___________________
__________________________________, DOB ___________________
and Defendant shall have physical custody of the following minor child(ren):
__________________________________, DOB ___________________
__________________________________, DOB ___________________
( I ) PARENTING TIME (aka Visitation)
(If you check more than 1 box in the Parenting Time section, or have failed to complete
the checked section completely, your order will not be approved by the Court)
The Plaintiff Defendant shall have reasonable rights of parenting time with the
minor child(ren) of the parties. Should the parties become unable to agree upon terms of
reasonable parenting time which are not otherwise Court-ordered, then the Cass County
Friend of the Court’s written reasonable parenting time policy currently in effect when the
need for clarification or conflict resolution arises shall be applied, until further Order of this
Court.
The parents shall share parenting time equally on a week on, week off basis, with the
exchange of the child(ren) occurring on the following day of every week,
___________________________, at ________________________ a.m./p.m.
The parents sharing parenting time according to the following schedule:
Stipulation to Modify Custody, PT, and CS (04/19)
The Plaintiff Defendant shall have parenting time as follows:
The Plaintiff Defendant shall have supervised parenting time with the minor
child(ren) as follows:
a) The name of the person who will supervise the parenting time:
____________________________________________________________
b) The relationship of that person to the children: ______________________
c) Where the parenting time will occur: _______________________________
d) The days and times the parenting time will occur:
_______________________________________________________________
_______________________________________________________________
The parenting time Plaintiff Defendant shall be reserved at this time for the
following reasons:
Stipulation to Modify Custody, PT, and CS (04/19)
INTERNATIONAL PARENTING TIME
Neither parent shall exercise parenting time in a foreign country/nation that is not a party to
the Hague convention on the Civil Aspects of International Child Abduction; however, this
prohibition does not apply with both parents’ written consent.
IMPACT OF POSSIBLE PERSONAL PROTECTION ORDER
In the event a Personal Protection Order (PPO) exists between these parties, those specific
provisions which limit or prohibit contact between these parties shall control the conduct of
the parties during custody/parenting times set forth in this Order.
However, this Order has priority over any PPO in the granting of custody/parenting time, and
the parties shall make alternative arrangements necessary to carry out all Court-ordered
custody/parenting time, so as not to violate any PPO, while still ensuring that all Court-
ordered custody/parenting time occurs as ordered herein.
( J ) RESIDENCE OF MINOR CHILD(REN)
A parent whose custody or parenting time of a child is governed by this Order shall not
change the legal residence of the child except in compliance with section 11 of the Child
Custody Act, MCL 722.31.
The parties agree the residence of the minor child(ren) shall be as follows: Attach on a
separate sheet (must be included if this option is selected).
DOMICILE OF MINOR CHILD(REN)
The domicile or residence of the minor child(ren) may not be moved outside the state of
Michigan without the prior approval of this Court by way of a Court Order allowing such a
move.
NOTICE OF ADDRESS CHANGE OF CHILD(REN)
The person(s) awarded custody shall promptly notify the Cass County Friend of the Court in
writing whenever a child is moved to any new address.
INALIENABLE RIGHTS OF EACH CHILD
The parents shall cooperate with respect to each child so as, in a maximum degree, to
advance each child's health, emotional, and physical well-being and to give and afford each
child the affection of both parents and a sense of security.
Neither parent will, directly or indirectly, influence a child so as to prejudice a child against the
other parent. The parents will endeavor to guide each child so as to promote the affectionate
relationship between each child and the mother and each child and the father.
Stipulation to Modify Custody, PT, and CS (04/19)
The parties will cooperate with each other in carrying out the provisions of this order for each
child's best interests.
Whenever it seems necessary to adjust, vary, or increase the time allotted to either party, or
otherwise take action regarding a child, each of the parties shall act in the best interests of
each child.
Neither party shall do anything which may estrange the other party from a child, injure a
child's opinion of the other party, or which will hamper the free and natural development of an
otherwise natural parent/child relationship between a child and the other party.
( K ) RIGHT TO CLAIM MINOR CHILD(REN) FOR TAX PURPOSES
(This provision is optional)
Mother has the right to claim the following minor child(ren) for State and Federal income
tax purposes in even years in odd years every year:
__________________________________, DOB ___________________
__________________________________, DOB ___________________
__________________________________, DOB ___________________
__________________________________, DOB ___________________
Father has the right to claim the minor child(ren) of the parties for State and Federal
income tax purposes in even years in odd years every year:
__________________________________, DOB ___________________
__________________________________, DOB ___________________
__________________________________, DOB ___________________
__________________________________, DOB ___________________
The parties shall cooperate with each other and sign any forms which are necessary
(currently IRS form 8332), or be subject to the contempt powers of this Court upon their
failure to do so.
The Payer of child support shall only be entitled to claim the minor child(ren) as set forth
herein if he/she is in substantial compliance with his/her court ordered child support
obligations as of January 1
st
following the tax year for which he/she is attempting to claim the
child(ren).
( L ) SUPPORT OF CHILDREN
The application of the Michigan Child Support Formula to set the child amount is mandatory,
except in very limited circumstances. Upon entry of the order based upon this stipulated
agreement, the Friend of the Court shall commence a child support review and issue a
recommendation as to the amount of child support. Unless a party objects to the
Stipulation to Modify Custody, PT, and CS (04/19)
recommendation and requests a hearing, the recommendation shall become the order of the
court, effective the date the order approving this stipulated agreement was entered.
HEALTH-CARE COVERAGE AND EXPENSES
Both Plaintiff and Defendant are ordered to obtain and maintain health-care coverage as
provided for in the Uniform Child Support Order, which is attached and incorporated herein by
reference.
The parties’ present health-care coverage information is:
( M )
Present Name of
Insurance Co./HMO
Type/Group No./Policy
No.
Plan Administrator
Address
Plaintiff
Defendant
If a party has no health care coverage, put “None” in the space for the name of the Insurance Company/HMO
The Plaintiff and Defendant shall each forthwith provide the other party, and the Friend of the
Court, upon request, with any and all documentation necessary for that party to utilize any
healthcare coverage available for a minor child, including but not limited to insurance cards,
explanations or listings of benefits, and/or claim forms and instructions for filing a claim.
Remedial health-care expenses (cough syrup, Band-Aids, non-prescription medications, etc.)
shall be the responsibility of the parent with whom a child is staying with at the time the need
for such care shall arise.
Uninsured health-care expenses shall be apportioned between the parents and paid pursuant
to the Uniform Child Support Order, which is attached and incorporated herein by reference.
DIRECT PAYMENT IS A GIFT
On or after the entry date of this Judgment, any payment made by the Payer directly to the
Payee shall be considered a gift, and no credit will be issued by the Cass County Friend of
the Court.
TITLE IV-D/DEPARTMENT OF HUMAN SERVICES INVOLVEMENT
In the event an order suspending child support is entered herein, and/or subsequent to this
Order, and a child is certified to become supported by public assistance, or is re-certified to
receive public assistance, then the child support charges, applicable statutory fees, and the
automatic enforcement of child support shall be established commencing on that Monday, or
the first Monday following date of certification or recertification. Child support charges shall be
in the amount last ordered by this Court, or as established through a support establishment
procedure if not previously ordered.
Stipulation to Modify Custody, PT, and CS (04/19)
INCOME WITHHOLDING-ADDITIONAL PROVISIONS
Extraordinary income, including but not limited to bonus, incentive and vacation pays, are
subject to up to 50% withholding, over and above ordered regular monthly payment of
arrears. In the event the Payer is self-employed, the Payer shall make payments directly to
Michigan State Disbursement Unit/MISDU in Lansing.
The Payer shall provide the Cass County Friend of the Court the name, address and
telephone number of their employer(s) and/or any other source(s) of income which are
subject by law to withholding, and shall immediately give the Cass County Friend of the Court
notice of any subsequent change or addition to their current source(s) of income subject by
law to withholding. This notification requirement includes changes in benefits of employment,
income or healthcare coverage.
The Payer’s current employer(s) and/or source(s) of income is/are:
ARREARAGE
As of the entry date of this Order, any arrearage in fees and costs shown on Friend of the
Court records as owing are hereby preserved. In the event statutory fees arrearage exceeds
$50, then said arrearage shall be paid at the rate of $25 per month until paid in full.
The monthly repayment amount on arrearage shall be two percent of the total support
arrearage at the time of the review, but not less than $50, nor more than half of the current
support amount. If no current support charge exists, the monthly repayment amount shall be
the last ordered support charge amount.
To repay arrearages as quickly as possible, the “total payment amount” (defined in MCSF
§4.02(E)(4)) used for determining the repayment amount for collection shall be:
a) the higher of the most recent total payment amount, or
b) the total payment amount presently figured using the arrearage payment calculation
and current support charge.
If the current support charge is reduced because of a reduction in payer’s income, the
repayment amount shall be recalculated using the arrearage payment calculation (MCSF
§4.02(B)(3)) and the reduced support charge. If the most recent total payment amount is the
payment amount chosen, the aggregate amount remains the same, but consists of a reduced
support and an increased repayment amount (MCSF §4.02(B)(8).
If arrearage exists when a current support obligation terminates or is reduced for reasons
other than a reduction in the payer’s income, there shall be no automatic reduction in the total
payment amount unless ordered by the court. The reductions in the current support amount
shall be added to the repayment amount and become the new repayment amount. The total
Stipulation to Modify Custody, PT, and CS (04/19)
payment amount remains in effect until the arrearage has been paid in full or until modified or
adjusted by the court or friend of the court.
TAX OFFSET PAYMENT
Arrearage qualifying for the Tax Offset Program will be submitted to the Internal Revenue
Service and Michigan Department of Treasury for interception of the Payer’s income tax
refund(s).
WHEREFORE, THE PARTIES REQUEST that an Order reflecting the agreements set forth
above shall enter.
(N)__________________________
Mother’s Signature Date
STATE OF _________________)
COUNTY OF _______________ )
Before me, Notary Public in and for said
County and State appeared the
Hereinabove subscribed party, who
acknowledge that s/he did sign the
foregoing instrument & the same is their
free act deed.
_____________________________
Notary Public
In and For ______________County,
State of ______________________
My Commission Expires:
_____________________________
(O)__________________________
Father’s Signature Date
STATE OF __________________)
COUNTY OF________________ )
Before me, Notary Public in and for said
County and State appeared the
Hereinabove subscribed party, who
acknowledge that s/he did sign the
foregoing instrument & the same is their
free act deed.
_____________________________
Notary Public
In and For ______________County,
State of ____________________
My Commission Expires:
____________________________
Approved & Recommended for entry:
_________________________
Attorney Referee
Stipulation to Modify Custody, PT, and CS (04/19)
STATE OF MICHIGAN
IN THE CIRCUIT COURT FOR THE COUNTY OF CASS
FAMILY DIVISION
___________________________________
File No.
ATTACHMENT 1:
Stipulation to Modify Custody
Joint Physical Custody Arrangement
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
(attach additional sheets as necessary)
__________________________ ____________________________
Plaintiff’s Signature/Date Defendant’s Signature/Date
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Cass County Friend of the Court (Cass County Michigan Courts)

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Completed 6 June 2021

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