Approved, SCAO
Original - Friend of the court
Copy - Filing party
STATE OF MICHIGAN
CHANGE IN PERSONAL INFORMATION
CASE NO.
46th
JUDICIAL CIRCUIT
Otsego
COUNTY
Friend of the court address Telephone no.
800 Livingston Blvd Ste 1A Gaylord, MI 49735 (989)731-7450
Please type or print information. Complete only those sections that apply. You can only file changes for yourself or those minor children
of whom you have physical custody. Use another form when making changes for more than one person. You must sign this form
and send it to the friend of the court.
for party and minor child(ren) for party only
1. New Address and/or Telephone Number
for minor child no longer living with custodial parent
Name
Street address
City State Zip Area code and telephone number
I understand that by filing this change of address, it will be used to automatically update address information on any other child-
support cases I have in Michigan. This change is effective for (check all that apply)
all addresses you have listed for me.
residence address only (where I live).
an address that is confidential by court order and which remains confidential with this change.
the single mailing address to which all notices and papers will be served.
2. Alternate Address
The court has entered an order making my address confidential under Michigan Court Rule 3.203(F). The following is an alternate
address for the court, the friend of the court office, and the other party to use in serving me with notice and other court papers.
I will retrieve all my mail regarding this case from this alternate address.
Street address City State Zip
3. Name Change (Attach order changing name or certificate of marriage.)
New name
4. New Employer Employer information is confidential by court order.
Employer name Street address
City State Zip Area code and telephone number
5. New Driver's License
Issuing state License number Expiration date
6. New Occupational License
Issuing state Type of occupation License number Expiration date
7. New Social Security Number for you for minor child
Social security number Name
8. Health Care Insurance Provider
Provider name Provider address and telephone number Group number Policy number
9. Other Information: (To be provided as ordered by the court.) (Attach separate sheet.)
Signature of party filing the change Name of party filing the change (t
ype or print)
Date of filing Social security number E-mail address
FOC 108 (3/13) CHANGE IN PERSONAL INFORMATION
