Michigan > Statewide > Domestic Relations > General
Verified Statement FOC 23 - Michigan
| Verified Statement Form. This is a Michigan form and can be used in General Domestic Relations Statewide . |
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Original - Friend of the Court 1st copy - Plaintiff/Attorney Approved, SCAO 2nd copy - Defendant/Attorney STATE OF MICHIGAN CASE NO. JUDICIAL CIRCUIT VERIFIED STATEMENT COUNTY 1. Mothers last name First name Middle name 2. Any other names by which mother is or has been known3. Date of birth 4. Social security number 5. Driver license number and state6. Mailing address and residence address (if different) 7. Eye color 8. Hair color 9. Height 10. Weight 11. Race 12. Scars, tattoos, etc. 13. Home telephone no. 14. Work telephone no. 15. Maiden name 16. Occupation 17. Business/Employers name and address 18. Gross weekly income 19. Has wife applied for or does she receive public assistance? If yes , please specify kind. 20. AFDC and recipient identification numbers Yes No 21. Fathers last name First name Middle name 22. Any other names by which father is or has been known23. Date of birth 24. Social security number 25. Driver license number and state26. Mailing address and residence address (if different) 27. Eye color 28. Hair color29. Height 30. Weight 31. Race 32. Scars, tattoos, etc. 33. Home telephone no. 34. Work telephone no. 35. Occupation 36. Business/Employers name and address 37. Gross weekly income 38. Has husband applied for or does he receive public assistance? If y es, please specify kind. 39. AFDC and recipient identification numbers Yes No 40. a. Name of Minor Child Involved in Case b. Birth Datec. Age d. Soc. Sec. No. e. Residential Address 41. a. Name of Other Minor Child of Either Party b. Birth Datec. 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/Contract43. Names and addresses of person(s) other than parties, if any, who may have custody of child(ren) during pendency of this case If any of the public assistance information above changes before your ju dgment is entered, you are required to give the Friend of the Court written notice of the change. I declare that the statements above are true to the best of my informati on, knowledge, and belief. Date Signature FOC 23 (5/93) VERIFIED STATEMENT MCR 3.206(B)
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