Fillable SUSPENSION OF FEES/COSTS v STATE OF MICHIGAN CASE (Third Judicial Circuit of Michigan)

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SUSPENSION OF FEES/COSTS v STATE OF MICHIGAN CASE (Third Judicial Circuit of Michigan)

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AFFIDAVIT
1. The attached pleading is to be filed with the court by or on behalf of ,
applicant, who is plaintiff/petitioner. defendant/respondent.
2. The applicant is entitled to and asks the court for suspension of fees and costs in the action for the following reason:
a. S/he is currently receiving public assistance: $ per Case No.: .
b. S/he is unable to pay those fees and costs because of indigency, based on the following facts:
INCOME:
per week. month. two weeks.
ASSETS: State value of car, home, bank deposits, bonds, stocks, etc.
OBLIGATIONS: Itemize monthly rent, installment payments, mortgage payments, child support, etc.
3. The number of people living in the applicant's household is .
4. (in domestic relations cases only) The applicant is entitled to an order requiring his/her spouse to pay attorney fees.
REIMBURSEMENT: It is understood that the court may order the applicant to pay the fees and costs when the reason for the waiver
or suspension no longer exists.
Subscribed and sworn to before me on , County, Michigan.
My commission expires: Signature:
Notary public, State of Michigan, County of
Court telephone no.
MC 20 (5/07)
AFFIDAVIT AND ORDER, SUSPENSION OF FEES/COSTS
Court address
MCR 2.002
Approved, SCAO
2nd copy - Opposing party
PROBATE OSM CODE: OSF
STATE OF MICHIGAN CASE NO.
AFFIDAVIT AND ORDER
SUSPENSION OF FEES/COSTS
JUDICIAL DISTRICT
JUDICIAL CIRCUIT
COUNTY PROBATE
v
Defendant/Respondent name, address, and telephone no.Plaintiff/Petitioner name, address, and telephone no.
Defendant's/Respondent's attorney, bar no., address, telephone no.
Plaintiff's/Petitioner's attorney, bar no., address, telephone no.
Probate In the matter of
Employer name and address
Length of employment Average gross pay Average net pay
Name
Date
Date
Deputy clerk/Register/Notary public
Affiant signature
(SEE REVERSE SIDE FOR ORDER)
NOTE: Requests for waiver/suspension of transcript
costs must be made separately by motion.
Original - Court
1st copy - Applicant
CERTIFICATION OF ATTORNEY
1. I have reviewed the affidavit of indigency, and I certify that its contents are true to the best of my information, knowledge, and
belief.
2. I will bring to the court's attention the matter of suspended costs and fees and the availability of funds to pay them before
any disposition is entered. I will report at that time any changes in the information contained in the affidavit of indigency or
any other information regarding the affiant's financial status or alterations of the fee arrangement.
CERTIFICATION BY PERSON OTHER THAN PARTY
1. I have personal knowledge of the facts appearing in the affidavit.
2. The person in whose behalf the petition is filed is unable to sign it because of
minority: other disability:
Relationship:
ORDER
IT IS ORDERED:
1. Fees and costs in this action required by law or court rule are waived/suspended until further order of the court. Before
any final disposition or discontinuance is entered, the moving party shall bring the fee and costs suspension to the
attention of the judge for final disposition.
2. The applicant's spouse shall pay the fees and costs required by law or court rule.
3. This application is denied.
Date of birth Nature of disability
Bar no.
Attorney signature
Attorney name (type or print)
Date
Affiant name (type or print)
Date Affiant signature
Address
City, state, zip
Telephone no.
Date Judge/Magistrate
Bar no.
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SUSPENSION OF FEESCOSTS v STATE OF MICHIGAN CASE (Third Judicial Circuit of Michigan)

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Completed 29 July 2020

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