Fillable Form 46: JUDICIAL CIRCUIT OTSEGO COUNTY You must (County of Otsego)

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Form 46: JUDICIAL CIRCUIT OTSEGO COUNTY You must (County of Otsego)

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BROWSE COUNTY OF OTSEGO (MI) FORMS

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Rev:1/3/2017 1
46
th
JUDICIAL CIRCUIT
OTSEGO COUNTY
You must utilize the attached form Judgment of Divorce and Uniform Child Support Order when
presenting the Judgment for approval by the friend of the court and for signature by the Court.
Other form Judgments will not be approved as they do not contain all of the required statutory
language.
OPT OUT
JUDGMENT OF DIVORCE INSTRUCTIONS
The Friend of the Court is required to approve your Judgment of Divorce even
though you have opted out or have a motion pending to opt out of friend of the court
services. Proper completion of the Judgment will allow for less chance of delay in the entry of
your Judgment.
Once the Judgment and attached Uniform Support Order(s) has been completely and
properly filled in, it will need to be approved by the friend of the court before your final divorce
hearing date. It may be mailed or brought to the friend of the court office to be reviewed. This
needs to occur no less than 30 days prior to your hearing date. If the Judgment cannot be
approved due to the Judgment and/or attachment(s) not being properly filled out, you will be
notified to make the necessary changes. The Judgment will again need to be submitted to the
friend of the court for approval. You will need to bring your approved Judgment with you to
your final divorce hearing. The Judge will not sign the Judgment and Uniform Support Order(s)
until it has been approved by the friend of the court and you have filed a Proof of Service with
the county clerk indicating that you have served a copy of the Judgment Information Form on the
friend of the court.
It is your responsibility to schedule your final hearing through the Assignment Clerk of
the county in which your case is file in Otsego County contact:
Jennifer O’Rourke (cases assigned to Judge George Mertz) at (989)731-0224
Christina Ventline (cases assigned to Judge Colin Hunter) at (989) 344-3271
If you already have an order exempting your case from friend of the court services, after
the final hearing you will need to take the Judgment of Divorce and Uniform Support Order(s) to
the county clerk for filing. If your order exempting the case from friend of the court services
provides for income withholding or, if your motion to exempt your case from friend of the court
services was heard at the same time as your final judgment hearing, you will need to provide a
copy of both the exemption order and the Judgment of Divorce to the county clerk marked
“friend of the court copy”. Your divorce is not complete until you properly file the Judgment
and Uniform Support Order(s) with the clerk. You are responsible for supplying the Defendant
with a copy of the Judgment and Uniform Support Order(s) within seven days from the date
they were signed by the Judge. A Proof of Service form is included with this packet. You will
need to complete and file the Proof of Service with the county clerk along with a copy marked
“friend of the court copy”.
Rev:1/3/2017 2
CHILD SUPPORT INFORMATION
Pursuant to the 2017 Michigan Child Support Formula, child support must be calculated
to take into account the number of overnights (parental time offsets) exercised by both parents.
If in your proposed Judgment of Divorce you and the Defendant have agreed to a parenting time
schedule that changes the number of overnights used in the support recommendation, you must
advise the friend of the court at least two weeks prior to your final hearing of your agreed upon
schedule and the number of annual parenting time overnights for both you and the Defendant. A
new support recommendation will then be prepared based upon the correct number of overnights
to allow an accurate support figure to be recorded in the proposed Judgment of Divorce. Note
that if you are deviating from the child support formula recommended amount of support you
will need to explain, in detail, your reasons for the deviation.
As a reminder, you are under Court order to complete the S.M.I.L.E. program prior to
your final judgment hearing. Failure to comply with this order may result in a delay of the entry
of your Judgment of Divorce.
Note: The friend of the court cannot give you legal advice. You may wish to consult with an
attorney or you can access MichiganLegalHelp.org for legal assistance.
INSTRUCTIONS FOR COMPLETING IN PRO PER JUDGMENT OF DIVORCE
Where stated in directions "FOC Rec." refers to friend of the court recommendation.
Where stated "PL" refers to Plaintiff and "DF" refers to Defendant. Areas in the Judgment of
Divorce that are not numbered for you to complete are to be completed by the Court.
(01) Fill in the County in which your case is filed (Otsego)
(02) The complete name of the party who filed the Complaint for Divorce (PL) and the
complete name of the other party (DF)
(03) The file number of your case. (see Complaint for Divorce or FOC Rec.)
(04) The name of the Judge presiding over your case. (See Complaint for Divorce)
(05) Check Consent or Default: Consent means the content of the Judgment of Divorce
is based upon agreement of the parties. The Defendant must sign the Judgment.
Default means the Defendant did not file an Answer to the Complaint for Divorce.
(06) Complete the child(ren)'s name, date of birth and assignment of legal and physical
custody. Custody is pursuant to mutual agreement, default, and or previous order
of the court. (see abbreviations under custody)
(07) Fill in the party who will be entitled to parenting time (PL or DF)
(08) If parenting time differs from the 46
th
Circuit parenting time policies, state the
parenting time as agreed by both parties.
(08A) Count the annual number of overnights each child will spend with PL and DF in a
calendar year and fill in the numbers appropriately. If no parenting time is
proposed, you must use “0”. Note that the Plaintiff and Defendant’s overnights
with each child must total 365.
(09) Check the appropriate box. If you checked box #1 you must complete the
attached Uniform Child Support Order (see instructions below). Check the
deviation box (a) if you have deviated from the Michigan Child Support Formula.
You must complete the attached Uniform Support Order Deviation Addendum
Rev:1/3/2017 3
(FOC form 10d).
(10) Complete this section if you have filed a motion to opt out of friend of the court
services and it is scheduled to be heard on the same date as your final judgment
hearing.
(11) Insert residential address of PL and DF from Verified Statement
(12) Check the appropriate box. If box #2 is checked you must complete and attach
the Uniform Spousal Support Order (Form FOC10c).
(13) Complete maiden name (If applicable)
(14) (15) (16) Attachments if applicable
(17) PL signature and date.
(18) DF signature and date
INSTRUCTIONS FOR COMPLETING THE UNIFORM CHILD SUPPORT ORDER
Form FOC10a – No Friend of the Court Services
1. Fill in the Case No. in the upper right hand corner of the form.
2. Fill in the complete name of the party who filed the Complaint for Divorce (Plaintiff) and
the complete name of the other party (Defendant), addresses and telephone numbers.
3. Fill in the name, address bar no. and telephone number of the Plaintiff and Defendant’s
attorneys, if applicable.
4. Fill in the Plaintiff’s source of income (employer) including the address and telephone
number. Do the same for the Defendant.
5. Under Item #1enter the following information:
a. Indicate the name of the payer, payee, list the children’s names and dates of birth and
the number of parenting time overnights with the payer of support for each child.
Depending upon the parenting time that will be ordered, the number of overnights may
vary for each child. If you are adopting the standard parenting time schedule, the number
of overnights is set forth in this court’s parenting time guideline included in this packet.
If a party has no overnights, you must use “0”.
b. Enter the effective date of the support order.
c. List the amount of base support, any health care premium adjustment, ordinary
medical, child care, other support or social security benefit credit (if applicable). Refer to
the FOC recommendation. If you are deviating from the friend of the court
recommendation, list the amounts of base support, child care, ordinary medical and other
support for each child that you have agreed upon.
6. Check the box under the support grid if a previous court order for support was entered
and this order is based upon reduced income of the payer.
7. Page 2 – Fill in the case number at the top of the page.
8. Uninsured Health-Care Expenses - Fill in the uninsured health care expense
percentages from the FOC recommendation. If you are deviating from the child support
formula, fill in the percentages that you have agreed upon. The annual ordinary medical
amount is $403 per child as indicated in the friend of the court recommendation.
9. Obligation Ends- Child support will end for each child on the last day of the month the
child turns 18 unless a specific graduation date (month, date, year) is listed under Post-
majority Support. If a child will continue to attend high school beyond age eighteen
and you wish to have support continue while the child is attending school on a full time
basis (up to age nineteen and a half (19 ½), check the box and insert the expected
graduation date for each child you list.
Rev:1/3/2017 4
10. Under item #2 - Unless you agree otherwise, this court requires the friend of the court to
recommend which parent should maintain health insurance, not to exceed 6% of
gross income. Either record your agreement or use the FOC recommendation that reflects
which parent is determined to carry the dependent insurance.
11. Under item #8 – Check the box if you are deviating from the friend of the court
recommendation which is based upon the Michigan Child Support Formula. If this box is
checked you must complete the Uniform Support Order Deviation Addendum (Form
FOC 10d included in this packet) and attach it to the Uniform Support Order (See
instructions below).
Note: You cannot opt out of friend of the court services nor deviate from the
Michigan Child Support Formula if you are receiving public assistance (FIP, food
stamps, Medicaid, child day care assistance).
12. Under item #9 include any other agreements related to child support, including health
care.
NOTE: This Uniform Support Order will supersede all prior child support orders. All continuing
provisions must be stated in this order or they will no longer exist. Prior Uniform Support Orders
cannot be incorporated by reference in your Judgment of Divorce.
INSTRUCTIONS FOR COMPLETING THE UNIFORM CHILD SUPPORT ORDER
DEVIATION ADDENDUM (Form FOC 10d)
1. Fill in the complete name of the Plaintiff and Defendant.
2. Under item #1 indicate the number(s) of the paragraph(s) in which you have deviated
rom the Michigan Child Support Formula.
3. Under item #2a fill in the support, health care and insurance information included in the
friend of the court recommendation (what you may be deviating from).
4. Under item #2b indicate the specific reasons you are requesting the court to allow a
deviation from the Michigan Child Support Formula.
5. Under item #2c specify which the provisions of the child support formula create an
unjust or inappropriate result and explain how this deviates from the provisions.
6. Under item #2d indicate the value of property or other support award instead of payment
of child support. If this is not applicable, write “none.”
STATE OF MICHIGAN
IN THE 46
TH
CIRCUIT COURT - FAMILY DIVISION
FOR THE COUNTY OF __OTSEGO__ (01)
(02)_____________________________
Plaintiff,
vs. (03) File No.______________________
(02)_____________________________ (04) Honorable____________________
Defendant
JUDGMENT OF DIVORCE
(05)( )CONSENT ( )DEFAULT
Date of Hearing ________________________
It appears to this Court that the material facts alleged in the Complaint are true,
and that there has been a breakdown in the marriage relationship to the extent that the
objects of matrimony have been destroyed and there remains no reasonable likelihood
that the marriage relationship can be preserved,
IT IS ORDERED that the marriage between the Plaintiff and Defendant is
dissolved and a divorce is granted.
CUSTODY
IT IS FURTHER ORDERED that the custody of the minor child(ren) will be as
follows:
Custody: PL=Plaintiff DF=Defendant JT=Joint 3
rd
=Third party/Guardian
(06) Child’s name Date of Birth Legal Custody Physical Custody
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
until each child is age eighteen or until further order of the court.
1.
If the parties are awarded joint legal custody they shall share the decision-
making authority as to important decisions affecting the welfare of the child(ren).
PARENTING TIME
IT IS FURTHER ORDERED that (07) _____________________________shall
have the right to reasonable parenting time with the minor child(ren)of the parties
pursuant to the attached standard parenting time schedule, unless other wise
hereinafter provided.
(08)__________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
(08A) The above parenting time arrangements result in a number of overnights in a
calendar year for each child as follows:
Child’s name # Plaintiff overnights # Defendant overnights
_____________________________________________________________________
_________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
HAGUE CONVENTION/INTERNATIONAL CHILD ABDUCTION
Pursuant to MCL 722.27a (9) parenting time is prohibited from being exercised in
a foreign country/nation that is not a party to the Hague convention on the civil aspects
of international child abduction unless both parents provide the court with written
consent to allow parenting time to take place in a foreign country/nation that is not a
party to this convention.
2.
INHERENT RIGHTS OF THE CHILD(REN)
The parents shall cooperate with respect to a child so as, in a maximum degree,
to advance a child’s health, emotional, and physical well-being and to give and afford a
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 a child so as to promote the affectionate relationship
between a child and the mother and a child and the father. The parties will cooperate
with each other in carrying out the provisions of this order for a 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 the child. Neither party shall do anything which may estrange the other
from the child, injure the child’s opinion of the other party, or which will hamper the free
and natural development of the child from the other party.
SUPPORT AND HEALTH CARE OF THE MINOR CHILD(REN)
IT IS FURTHER ORDERED: (09)
1. Support and health care expenses shall be paid as outlined in the attached
Uniform Child Support Order (Form FOC10a).
a. Support deviates from the Michigan Child Support Formula as
outlined in the attached Uniform Support Order Deviation Addendum
(Form FOC 10d).
2. No Uniform Child Support Order is required because support is reserved.
The child support and health care obligations shall end on the last day of the
month each child turns age 18 unless otherwise stated in the Uniform Support Order
attached to this Judgment.
CHILD CARE EXPENSES
IT IS FURTHER ORDERED that child care expenses shall be paid as outlined in
the attached Uniform Child Support Order and shall continue through August 31
st
following the child’s 12
th
birthday. The parties must notify each other of changes in
child care expenses. A failure to report will be reviewed as an affirmative assertion
there has been no change.
OPTING OUT OF FRIEND OF THE COURT SERVICE
In cases where the parties agree to opt out of the services of the friend of the
court, the Court finds this case has met the requirements for authorization under MCL
552.505a for the parties to opt out of friend of the court services. The attached motion
3.
was filed by the (10) _____________________ on ____________________ to be
heard on ____________________in conjunction with the Judgment of Divorce. The
Plaintiff and Defendant have read and signed the attached Advice of Rights Regarding
Friend of the Court Services.
IT IS FURTHER ORDERED the attached signed Order Exempting Case from
Friend of the Court Services shall enter as a part of this judgment, effective upon entry
of this Judgment of Divorce.
IT IS FURTHER ORDERED:
1. Support and health care expenses shall be paid as outlined in the attached
Uniform Child Support Order (Form FOC 10a/ No Friend of the Court
Services).
a. Support deviates from the Michigan Child Support Formula as
outlined in the attached Uniform Support Order Deviation Addendum
(Form FOC 10d).
2. No Uniform Child Support Order is required because support is reserved.
DOMICILE OF CHILDREN
IT IS FURTHER ORDERED that the domicile or residence of said minor
child(ren) shall not be removed from the State of Michigan without prior approval of this
Court.
LEGAL RESIDENCE OF THE CHILDREN
A child whose parental custody is governed by the Judgment of Divorce has a
legal residence with each parent unless this judgment grants sole legal custody to one
of the child’s parents. A parent of a child whose custody if governed by this Judgment
of Divorce shall not change a legal residence of the child to a location that is more than
100 miles from the child’s legal residence with the other party at the time of the
commencement of the action unless that change is permitted by this Court or unless
allowable under Michigan Complied Law 722.31.
The legal residence of the child(ren) with the Plaintiff as it appears on the verified
statement
(11):
_____________________________________________________________________
The legal residence of the child(ren) with the Defendant as it appears on the
verified statement (11):
_____________________________________________________________________
4.
SPOUSAL SUPPORT
IT IS FURTHER ORDERED: (12)
1. Neither Plaintiff nor Defendant is entitled to spousal support and no spousal
support is awarded and shall be forever bared, with no requirement of a Uniform
Spousal Support Order.
2. Spousal support is ordered as outlined in the attached Uniform Spousal
Support Order (FOC10c/No Friend of the Court Services).
RESTORATION OF MAIDEN NAME
IT IS FURTHER ORDERED that (13) _________________________ shall have
restored her maiden name or the name she legally bore prior to her marriage and that
she shall henceforth be known by the name of (13)____________________________.
STATUTORY INSURANCE PROVISION
IT IS FURTHER ORDERED that any right of either party in any policy or contract
of life, endowment or annuity insurance of the other, as a beneficiary are extinguished
unless specifically preserved by this judgment. (14) Attachment, if applicable.
PROPERTY SETTLEMENT
IT IS FURTHER ORDERED that the Plaintiff and Defendant are each awarded
those items of personal property now in his/her possession free and clear of any claim
by the other and subject to any indebtedness thereon, if any. Each party shall hold the
opposite party harmless from such indebtedness. (15) Specific property settlement
attached, if applicable.
DOWER RELEASE
IT IS FURTHER ORDERED that the provisions made for the wife and husband
in the property settlement are in lieu of any dower in the land of the other and each
shall hereafter hold their remaining land free, clear and discharged from any such
dower right of claim of the other. This provision shall also be in full satisfaction of all
claims that either may have in any property owned or hereafter owned, or in which
either has, or hereafter may have, any interest.
5.
PENSION, ANNUITY, AND RETIREMENT
IT IS FURTHER ORDERED that neither the Plaintiff nor the Defendant shall
claim any right to any pension, annuity, or retirement benefit of the other, whether
vested or not, nor to any accumulated contribution in any pension, annuity, or
retirement system belonging to the other, unless otherwise specified in this judgment.
(16) Attachment, if applicable.
EFFECTIVE DATE
IT IS FURTHER ORDERED that this judgment shall become effective
immediately after it is signed and filed with the Clerk of the Court.
This judgment resolves the last pending claim and closes this case, except for
any matter over which this court retains continuing jurisdiction by law.
Dated:______________________ ___________________________________
Judge
APPROVED AS TO FORM AND CONTENT:
(17)____________________________________ __________________________
Plaintiff Date
(18)___________________________________ __________________________
Defendant Date
________________________________________ __________________________
Friend of the Court Date
Deviation from Michigan Child Support Formula
6.
Rev. 12/2014
STATE OF MICHIGAN
JUDICIAL CIRCUIT
COUNTY
UNIFORM CHILD SUPPORT ORDER,
NO FRIEND OF THE COURT SERVICES
EX PARTE TEMPORARY
MODIFICATION FINAL
CASE NO.
FOC 10a / 52a (12/18) UNIFORM CHILD SUPPORT ORDER, NO FRIEND OF COURT SERVICES
MCL 552.14, MCL 552.517, MCL 552.517b(3),
MCR 3.211
Plaintiff’s name, address, and telephone no.
v
Defendant’s name, address, and telephone no.
Plaintiff’s attorney name, bar no., address, and telephone no. Defendant’s attorney name, bar no., address, and telephone no.
Plaintiff’s source of income name, address, and telephone no. Defendant’s source of income name, address, and telephone no.
Approved, SCAO
Court telephone no.Court address
2nd copy - Defendant
3rd copy - Friend of the court
Original - Court
1st copy - Plaintiff
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.)
46th
Otsego
800 Livingston Blvd. Ste 1A Gaylord, MI 49735
(989) 731-7450
Uniform Child Support Order, No Friend of the Court Services (12/18) Page
of
Case No.
1. Item 1 (continued).
Obligation Ends. Except for child care, or as otherwise ordered, support obligations for each child end on the last day of the
month the child turns age 18.
Post-majority Support: The following children will be attending high school on a full-time basis after turning 18 years
of age. Therefore, the support obligation for each specific child ends on the last day of the month as follows, except in
no case may it extend beyond the time the child reaches 19 years and 6 months of age:
(Specify name of child and date obligation ends.)
Child Care. The parties must notify each other of changes in child-care expenses and must additionally notify the friend of
the court if the changes end those expenses. The child-care obligation for each child ends on August 31 following the child’s
12th birthday, at which time the total child care obligation reduces by that child’s pro rata share unless specified differently in
this order.
2. Insurance. For the benefit of the children, the plaintiff defendant shall maintain health-care coverage through an
insurer (as defined in MCL 552.602) that includes payment for hospital, dental, optical, and other health-care expenses when
that coverage is available at a reasonable cost, including coverage available as a benefit of employment or under an
individual policy
up to a maximum of $
for plaintiff. up to a maximum of $
for defendant.
not to exceed 6% of the plaintiff’s/defendant’s gross income.
3. Qualified Medical Support Order. This order is a qualified medical support order with immediate effect pursuant to 29
USC 1169. Further details, as prescribed by 29 USC 1169(a)(3), are stated in item 9.
4. Retroactive Modification and Liens for Unpaid Support. Except as provided by MCL 552.603, support is a judgment the
date it is due and is not modifiable retroactively. Unpaid support is a lien by operation of law and the payer's property can be
encumbered or seized if an arrearage accrues in an amount greater than the periodic support payments payable for two
months under the payer's support order.
5. Change of Address, Employment Status, Health Insurance. Both parties shall notify each other in writing, within 21 days
of any change in: a) their mailing and residential addresses and telephone numbers; b) the names, addresses, and telephone
numbers of their sources of income; c) their health-maintenance or insurance companies, insurance coverage, persons
insured, or contract numbers; d) their occupational or drivers' licenses; and e) their social security numbers unless exempt
by law pursuant to MCL 552.603.
6. Foster-Care Assignment. When a child is placed in foster care, that child's support is assigned to the Department of Health
and Human Services while under the state's jurisdiction and to the funding county while placed in a county-funded program.
7. Prior Orders. This order supersedes all prior child support orders and all continuing provisions are restated in this
order. Past-due amounts owed under any prior support order in this case are preserved.
8. Michigan Child Support Formula Deviation The support provisions ordered do not follow the Michigan Child Support
Formula. The attached deviation addendum (FOC 10d) provides the basis for deviation and the required findings by the
court.
(Continued on page 3.)
Uninsured Health-Care Expenses. All uninsured health-care expenses exceeding the annual ordinary medical amount will
be paid
% by the plaintiff and
% by the defendant. Uninsured expenses exceeding the annual ordinary
medical amount for the year they are incurred that are not paid within 28 days of a written payment request may be enforced
by the friend of the court. The annual ordinary medical amount is
.
Uniform Child Support Order, No Friend of the Court Services (12/18) Page
of
Case No.
9. Other: (Attach separate sheets as needed.)
Plaintiff (if consent/stipulation) Date
Defendant (if consent/stipulation) Date
Plaintiff’s attorney Date
Defendant’s attorney Date
Prepared by:
Name (type or print)
Date
Judge Bar no.
I certify that on this date I served a copy of this order on the parties or their attorneys by first-class mail addressed to their last-
known addresses as defined in MCR 3.203. I certify that I also served the Deviation Addendum (FOC 10d) with this order.
Date
Signature
CERTIFICATE OF MAILING
COURT USE ONLY
Original – Court
2nd copy – Defendant
Approved, SCAO
1st copy – Plaintiff
3rd copy – Friend of the court
STATE OF MICHIGAN
UNIFORM CHILD SUPPORT ORDER
DEVIATION ADDENDUM (PAGE )
CASE NO.
46th
JUDICIAL CIRCUIT
Otsego
COUNTY
Court address
Court telephone no.
800 Livingston Blvd Ste 1A Gaylord, MI 49735
989-731-7450
Plaintiff’s name
Defendant's name
v
THE COURT FINDS:
1.
Paragraph(s)
In the preceding pages of the uniform order deviate from the Michigan Child Support
(specify paragraph number)
Formula and are warranted to avoid an unjust or inappropriate result.
2.
Pursuant to MCL 552.605(2), it has been determined from the facts of this case that:
a.
The child support obligation that would be ordered by applying the Michigan Child Support Formula is:
Payer:
Payee:
Children’s names, birth dates, and annual overnights with payer:
Children's names
Date of birth
Overnights
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.
Uninsured Health-Care Expenses. All uninsured health-care expenses exceeding the annual ordinary medical amount will
be paid
% by the plaintiff and
% by the defendant. Uninsured expenses exceeding the annual
ordinary medical amount for the year they are incurred that are not paid within 28 days of a written payment request may be
enforced by the friend of the court. The annual ordinary medical amount is
.
Insurance. For the benefit of the children, the plaintiff defendant shall maintain health-care coverage
through an insurer (as defined in MCL 552.602) that includes payment for hospital, dental, optical, and other health-care expenses
when that coverage is available at a reasonable cost, including coverage available as a benefit of employment or under an
individual policy
up to a maximum of $
for plaintiff. up to a maximum of $
for defendant.
not to exceed 6% of the plaintiff’s/defendant’s gross income.
(SEE SECOND PAGE)
MCL 552.517, MCL 552.517b(3),
MCL 552.605, MCR 3.211
FOC 10d (11/16) UNIFORM CHILD SUPPORT ORDER, DEVIATION ADDENDUM
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
Original – Court
2nd copy – Defendant
Approved, SCAO
1st copy – Plaintiff
3rd copy – Friend of the court
STATE OF MICHIGAN
UNIFORM CHILD SUPPORT ORDER
DEVIATION ADDENDUM (PAGE )
CASE NO.
46th
JUDICIAL CIRCUIT
Otsego
COUNTY
Court address
Court telephone no.
800 Livingston Blvd Ste 1A Gaylord, MI 49735
989-731-7450
Plaintiff’s name
v
Defendant’s name
(Item 2 continued.)
b.
Applying the Michigan Child Support Formula is unjust or inappropriate because: (Specify the deviation factors relied on.)
c.
The child support order deviates from the Michigan Child Support Formula as follows:
(Specify which provisions of the child support formula create an unjust or inappropriate result and explain how this order deviates from the provisions.)
d.
The value of property or other support awarded instead of the payment of child support: (If not applicable, put none)
Plaintiff (if consent/stipulation)
Date
Defendant (if consent/stipulation)
Date
Plaintiff’s attorney
Date
Defendant’s attorney
Date
Prepared by:
Name (type or print)
NOTE: When deviating, this form must be completed, attached, and served along with the rest of the Uniform Child Support Order. The proof of service
on the Uniform Child Support Order must indicate this form was included.
MCL 552.517, MCL 552.517b(3),
FOC 10d (11/16) UNIFORM CHILD SUPPORT ORDER, DEVIATION ADDENDUM
MCL 552.605, MCR 3.211
STATE OF MICHIGAN
IN THE 46TH CIRCUIT COURT - FAMILY DIVISION
FOR THE COUNTY OF OTSEGO
,
Plaintiff
vs. File No.
,
Defendant
PROOF OF SERVICE
JUDGMENT OF DIVORCE
I, ___, certify that on the day of____________
20 , I served a copy of the Judgment of Divorce, Uniform Support Order(s) and Order
Exempting the Case from Friend of the Court Services on all parties and their attorneys by:
Ordinary first class mail at
Personal service
I declare that the statements above are true to the best of my information, knowledge, and
belief.
Date:______________________ ___________________________________
Plaintiff
Revised 10/2014/Opt Out Judgment Packet
DOMESTIC RELATIONS
JUDGMENT INFORMATION, PAGE 1
TEMPORARY FINAL
USE NOTE: Complete this form and file it with the friend of the court (do not file this form with the office of the clerk of the court)
when the first temporary custody, parenting-time, or support order is entered and when submitting any final proposed judgment
awarding custody, parenting time, or support. Mail a copy to each party and file proof of mailing with the court (may use form MC
302, Proof of Mailing).
The information previously provided is changed is unchanged. (Complete only the fields that have changed.)
Name Name
Address Address
Social security number Telephone number Social security number Telephone number
E-mail address E-mail address
Employer name, address, telephone number, and FEIN (if known) Employer name, address, telephone number, and FEIN (if known)
Driver's license number and state Driver's license number and state
Occupational license number(s), type(s), issuing state(s), and date(s) Occupational license number(s), type(s), issuing state(s), and date(s)
CUSTODY PROVISIONS sole, plaintiff = P sole, defendant = D joint = J other = O
Child's name Social security Date of birth Physical Child's primary residence address Legal
number custody custody
P, D, J, O P, D, J, O
SUPPORT PROVISIONS
Support provisions are stated in the Uniform Support Order.
Medical Support provisions are stated on page 2 of this form.
FOC 100 (3/14) DOMESTIC RELATIONS JUDGMENT INFORMATION, PAGE 1
STATE OF MICHIGAN CASE NO.
JUDICIAL CIRCUIT
COUNTY
Date
Signature
Approved, SCAO
Plaintiff Information Defendant Information
Original - Friend of the court
Copies - All parties
MCR 3.211(F)
(must identify)
46th
Otsego
DOMESTIC RELATIONS
JUDGMENT INFORMATION, PAGE 2
TEMPORARY FINAL
MEDICAL SUPPORT PROVISIONS: List the name of each insurance provider for the plaintiff and the defendant. Then enter the
name of each child in this case who is covered by that provider and the type of coverage provided.
Plaintiff's Insurance Coverage
Provider name and address Policy/Group no. Cert. no. Child(ren)'s name(s) Medical Dental Optical Other
Defendant's Insurance Coverage
Provider name and address Policy/Group no. Cert. no. Child(ren)'s name(s) Medical Dental Optical Other
FOC 100 (3/14) DOMESTIC RELATIONS JUDGMENT INFORMATION, PAGE 2
STATE OF MICHIGAN CASE NO.
JUDICIAL CIRCUIT
COUNTY
Approved, SCAO
MCR 3.211(F)
Original - Friend of the court
Copies - All parties
46th
Otsego
On the date below I sent by first-class mail a copy of
to:
List names and addresses.
I declare that the statements above are true to the best of my information, knowledge, and belief.
Date Signature
Name (type or print)
Court telephone no.
MC 302 (3/08) PROOF OF MAILING
MCR 2.107(C)(3), (D)
Court address
CASE NO.STATE OF MICHIGAN
JUDICIAL DISTRICT
JUDICIAL CIRCUIT
COUNTY PROBATE
PROOF OF MAILING
v
Defendant(s)Plaintiff(s)
Probate In the matter of
Approved, SCAO
JIS CODE: POM
Juvenile In the matter of
46th
800 Livingston Boulevard Ste 1A Gaylord, MI 49735
(989)731-7450
Domestic Relations Judgment Information Form
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Form 46: JUDICIAL CIRCUIT OTSEGO COUNTY You must (County of Otsego)

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Completed 9 August 2020

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