Fillable Child Support Case Disclosure Form (Third Judicial Circuit of Michigan)

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Child Support Case Disclosure Form (Third Judicial Circuit of Michigan)

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A copy of this form is to be mailed to:
Wayne County Friend of the Court, Litigation Department, PO Box 310920, Detroit, MI 48231.
Attorney inquiries, please call: (313) 224-5295.
Public inquiries, please call: (877) 543-2660.
FD-FOC 4129 11/6/17
MCL 552.625a of the Support and Parenting Time Enforcement Act states that a child support
order acts as a lien against the payers real and personal property and any settlement received
from a lawsuit. The relevant section states:
(1) The amount of past due support that accrues under a judgment as provided in section 3 or
under the law of another state constitutes a lien in favor of the recipient of support against the
real and personal property of a payer, including, but not limited to, money to be paid as a
distribution from a decedent's estate; as the result of a claim for negligence, personal injury, or
death; under an arbitration award; under a settlement of or judgment issued in a civil action; or as
compensation under a worker's compensation order, settlement, redemption order, or voluntary
payment. The lien is effective at the time that the support is due and unpaid and continues until
the amount of past due support is paid in full or the lien is terminated by the title IV-D agency.
To that effect, please provide the following:
Name: ___________________________ Social Security Number: __________________
Address:________________________________________________________________
Phone: _____________________________Email: _______________________________
Current Employer: _________________________________________________________
Employer Address: ________________________________________________________
Child Support Docket/Case Number: __________________________________________
Other Party’s Name: _______________________________________________________
Child(ren)’s Name(s): ______________________________________________________
Child Support Docket/Case Number: __________________________________________
Other Party’s Name: _______________________________________________________
Child(ren)’s Name(s): ______________________________________________________
Wayne County Third Circuit Court
Child Support Case Disclosure Form
Civil Court
Civil Court Case Label or
Case Number:
___________________________
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Child Support Case Disclosure Form (Third Judicial Circuit of Michigan)

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Completed 4 February 2021

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