To: 43
Judicial Circuit Case No.
Friend of the Court
60296 M-62, Room 3
Cassopolis, MI 49031
We, and state
Plaintiff (print name) Defendant (print name)
that we reconciled on and are presently living together
at the following address:
street number/name apt/lot number city/state/zip code
and our phone numbers are:
Plaintiff’s phone number Defendant’s phone number
We understand that future changes in address and employment
must be reported in writing to the Friend of the Court
By our signatures below, we acknowledge our understanding of the following:
1. There will be no abatement (stoppage) of child support if public assistance is in place and both parents
are not on the grant.
Current child support charges will be abated the first of the month after the date the Friend of the Court is notified of
the reconciliation unless the Department of Human Services records reflect that the Custodial Parent and the minor
children are receiving public assistance and the other party is not listed as being in the home and/or on the same
grant as the Custodial parent and children.
2. All arrears are preserved and will continue to be collected.
All child support arrears, fees and costs that have accrued on the case are preserved in full and will be paid pursuant
to court order or the Friend of the Court policy on arrearage repayment. Income withholding will continue until all
support arrears, fees and costs have been paid. We understand that to waive any child support arrearage that
currently exists, we must complete a Stipulation asking the Court to enter an Order setting aside the arrearages.
3. We understand that this form DOES NOT dismiss our divorce action and that our divorce action
remains pending until further action by us or the Court.
We declare that the above statements are true to the best of our information, knowledge and belief. A
person who knowingly makes a false declaration may be sanctioned by the Court (MCR 2.114).
Plaintiff’s signature Date Defendant’s signature Date
Plaintiff’s Social Security Number Defendant’s Social Security Number
Plaintiff’s employer Defendant’s employer
Rev. 11/2015