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:
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
2nd copy - Opposing party
PROBATE OSM CODE: OSF
STATE OF MICHIGAN CASE NO.
AFFIDAVIT AND ORDER
SUSPENSION OF FEES/COSTS
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
Deputy clerk/Register/Notary public
(SEE REVERSE SIDE FOR ORDER)
NOTE: Requests for waiver/suspension of transcript
costs must be made separately by motion.
Original - Court
1st copy - Applicant