Michigan > Statewide > Domestic Relations > General
Domestic Relations Judgment Information FOC 100 - Michigan
| Domestic Relations Judgment Information Form. This is a Michigan form and can be used in General Domestic Relations Statewide . |
|
||||||
 Get this form for FREE as a print-only pdf |
|||||||
|
Approved, SCAO Original - Friend of the court Copies - All parties STATE OF MICHIGAN JUDICIAL CIRCUIT COUNTY DOMESTIC RELATIONS JUDGMENT INFORMATION, PAGE 1 MODIFICATION CASE NO. USE NOTE: Complete this form and file it with the friend of the court (do not file this form with the office of the clerk of the court) when the first temporary custody, parenting time, or support order is entered and when submitting any final proposed judgment awarding custody, parenting time, or support. Mail a copy to each party and file proof of mailing with the court using form MC 302, Proof of Mailing. (check this box when information is being modified) Except as otherwise indicated below, all information previously provided is unchanged. I declare that the statements below are true to the best of my information, knowledge, and belief. Date Signature Plaintiff Information Name Address Defendant Information Name Address Social security number Telephone number Social security number Telephone number Employer name, address, telephone number, and FEIN (if known) Employer name, address, telephone number, and FEIN (if known) Driver license number and state Occupational license number(s), type(s), issuing state(s), and date(s) Driver license number and state Occupational license number(s), type(s), issuing state(s), and date(s) CUSTODY PROVISIONS Child's name sole, plaintiff = P sole, defendant = D joint = J other = O (must identify) Social security Date of birth number Physical custody P, D, J, O Child's primary residence address Legal custody P, D, J, O SUPPORT PROVISIONS Support provisions are stated in the Uniform Support Order. . Medical Support provisions are stated on page 2 of this form. FOC 100 (11/05) DOMESTIC RELATIONS JUDGMENT INFORMATION, PAGE 1 MCR 3.211(F) American LegalNet, Inc. www.FormsWorkflow.com Approved, SCAO Original - Friend of the court Copies - All parties STATE OF MICHIGAN JUDICIAL CIRCUIT COUNTY DOMESTIC RELATIONS JUDGMENT INFORMATION, PAGE 2 MODIFICATION CASE NO. MEDICAL SUPPORT PROVISIONS: List the name of each insurance provider for the plaintiff and the defendant. Then enter the name of each child in this case who is covered by that provider and the type of coverage provided. Plaintiff's Insurance Coverage Name of provider Policy no. Cert. no. Child(ren)'s name(s) Medical Dental Optical Other Defendant's Insurance Coverage Name of provider Policy no. Cert. no. Child(ren)'s name(s) Medical Dental Optical Other FOC 100 (11/05) DOMESTIC RELATIONS JUDGMENT INFORMATION, PAGE 2 MCR 3.211(F) American LegalNet, Inc. www.FormsWorkflow.com
|
|||||||
