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Copy Request Form - Michigan

Copy Request Form Form. This is a Michigan form and can be used in Genesee Local County .
 Fillable pdf Last Modified 3/28/2007
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COPY REQUEST FORM CASE NUMBER______________________________ MAN'S NAME _______________________________ CASEWORKER ______________________________ S.S. NO. _____________________________________ BIRTHDATE ________________________________ WOMAN'S NAME ____________________________ S.S. NO. _____________________________________ BIRTHDATE ________________________________ CHILD(REN) `S NAME (S): ______________________________________ S.S. NO. ___________________________ D.O.B. _________________ ______________________________________ S.S. NO. ___________________________ D.O.B. _________________ ______________________________________ S.S. NO. ___________________________ D.O.B. _________________ ______________________________________ S.S. NO. ___________________________ D.O.B. _________________ I hereby request a copy of the following records contained in my file: __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ I understand that I must pay to the Genesee County Treasurer, on Account Number 10110-1415-75020, the costs of reproduction ($1.00 per page, per copy, plus postage) and present the receipt to the Friend of the Court before copies will be made and mailed to me. REQUESTED BY: ____________________________________ SIGNATURE DATED: _____________________________________________ CURRENT ADDRESS: COST OF COPIES: ________________ POSTAGE: ___________________________________________ TOTAL COST: ___________________________________________ RECEIPT NO.: ___________________________________________ AMOUNT: TELEPHONE NUMBER (8 A.M. TO 5 P.M.) ___________________________ COPIES MADE BY: _______________ ________________ ________________ ________________ ________________ __________________________________ DRIVER LICENSE NO. AND STATE copyreq/96 (updated 99) American LegalNet, Inc. www.FormsWorkflow.com
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