Michigan > Local County > Oakland > Family Division

Verified Statement - Michigan

Verified Statement Form. This is a Michigan form and can be used in Family Division Oakland Local County .
 Fillable pdf Last Modified 7/16/2015
Get this form for FREE as a print-only pdf

STATE OF MICHIGAN SIXTH JUDICIAL CIRCUIT OAKLAND COUNTY 1. Mother's last name 3. Date of birth First name CASE NO. VERIFIED STATEMENT Middle name 2. Any other names by which mother is or has been known 5. Driver license number and state E-Mail address 10. Weight 11. Race 15. Maiden name 12.. Scars, tattoos, etc. 16. Occupation 18. Gross weekly income 20. DHS case number 4. Social security number 6. Mailing address and residence address (if different) 7. Eye color 8. Hair color 9. Height 13. Home telephone number 14. Work telephone number 17. Business/Employer's name and address 19. Has mother applied for or does she receive public assistance? If yes, please specify kind. [ ] Yes [ ] No 21. Father's last name 23. Date of birth First name Middle name 22. Any other names by which father is or has been known 25. Driver license number and state E-Mail address 24. Social security number 26. Mailing address and residence address (if different) 27. Eye color 28. Hair color 29. Height 30. Weight 31. Race 35. Occupation 32.. Scars, tattoos, etc. 33. Home telephone number 34. Work telephone number 36. Business/Employer's name and address 38. Has father applied for or does he receive public assistance? If yes, please specify kind. [ ] Yes [ ] No 40. a. Name of minor child in case b. Birth date c. Age d. Soc. Sec. No. 37. Gross weekly income 39. DHS case number e. Residential address 41. a. Other minor child of either party b. Birth date c. Age d. Soc. Sec. No. e. Residential address 42. Health care coverage available for each minor child a. Name of minor child b. Name of Policy Holder c. Name of Insurance Co./HMO d. Policy/Certificate/Contract No. 43. Names and addresses of person(s) other than parties, if any, who may have custody of child(ren) during pendency of this case I request child support services available under title IV-D of the Social Security Act [ ] YES (enforcement, locator, future modification). Answering "YES" allows Oakland County to qualify for federal funding. PLEASE CHECK ! I declare that the statements above are true to the best of my information and belief. The Friend of the Court will not discriminate against any individual or group because of race, sex, religion, age, national origin, color marital status, 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 at the Friend of the Court office. FOC (6/12) Applicant's Signature (Signature is required) Date American LegalNet, Inc. www.FormsWorkFlow.com
Link/Embed this Document
URL
Embed


Popular Searches

  1. divorce forms
  2. abstract of judgment
  3. form interrogatories
  4. MOTION for continuance
  5. Affidavit of Indigency
  6. order of protection
  7. VERIFICATION
  8. Case Management Statement
  9. Petition for Summary Administration
  10. quit claim deed

Bookmark and Share