DHS-682 (10-12) MS Word
REQUEST FOR “MATCHING” PAYMENT
The Friend of the Court (FOC) office may “match” a payment. This means the FOC may remove one dollar
of debt you owe to the State of Michigan for every dollar you pay as a voluntary lump sum amount, up to the
amount owed for state-owed debt.
In order to qualify for matching, you must have first completed the Request to Discharge State-Owed Debt
(DHS-681). The FOC will review the DHS-681 to determine if you qualify. Upon approval by the FOC, please
complete this form and return it to the FOC with your payment.
Please read, complete, and sign the following:
I am requesting a match for my payment on my court order:
Name Docket
Other Parent/Custodian
Child(ren)
I am able to pay $________________ as a one-time payment on my past-due support.
I understand that I may not make this request if I purposely failed to pay my child support, or if I have enough
money and/or assets to pay all that I owe. I believe the information I have provided on this form is correct
and complete.
I understand that I must make my payment at the FOC office and include:
My name;
The amount I am paying;
The docket number that my payment applies to; and
The name of the other parent or custodian.
Otherwise, my payment may apply to other dockets that I have, and my state-owed debt on this docket may
not be removed.
I understand that if any of my state-owed debt is discharged based on incorrect, incomplete, or false
information I provided, the FOC may reinstate the debt forgiven (add it back to the total amount owed
in support).
Sign Name Date
Print Name
Department of Human Services (DHS) will not discriminate against any individual or group because of race, religion, age, national origin, color,
height, weight, marital status, sex, sexual orientation, gender identity or expression, political beliefs or disability. If you need help with reading, writing,
hearing, etc., under the Americans with Disabilities Act, you are invited to make your needs known to a DHS office in your area.
MAURA D. CORRIGAN
DIRECTOR
RICK SNYDER
GOVERNOR
S
TATE OF
M
ICHIGAN
DEPARTMENT OF HUMAN SERVICES
L
ANSING
