Request For Financial Information {JC 37}

Approved, SCAO STATE OF MICHIGAN CASE NO. JUDICIAL CIRCUIT - FAMILY DIVISION PETITION NO. REQUEST FOR FINANCIAL INFORMATION COUNTY TO WHOM IT MAY CONCERN: I authorize my employers, creditors and others who may have knowledge of my financial affairs to release information to the above court. A photocopy of this authorization shall suffice as an original. Date Signature Signature Please send information on the Name DOB Soc. sec. no. or employee/badge no.items checked below regarding: Hire date Number of dependents claimed EMPLOYMENT INFORMATION (or subsidy) EARNINGS DEDUCTIONS (other than taxes) Hourly Wage................................................................$Union dues ( check if required) $ per Average regular hours worked per weekX Insurance ( check if required) $ per Weekly straight time pay$ Credit union $ per Average overtime pay per week$ $ per Salary................................................$per $ per OTHER COMPENSATION $ per $ per $ per $ per OTHER (Pension, deferred compensation, stock plan, etc.) $ per FINANCIAL INFORMATION To be completed by banks, savings and loans, credit unions, loan companies, brokerage firms, etc.ASSETS (checking, savings, stocks, LOANS bonds, IRSs, etc.) Balance/Value Payment Balance $ Real Estate:$ $ per $ Motor Original loan $ Vehicle: $ per $ Make and year $ $ per $ $ $ per $ $ $ per $ Date Signature Title PLEASE RETURN THE ABOVE INFORMATION BY TO THE ADDRESS AT LEFT. Date THANK YOU. JC 37 (6/03) REQUEST FOR FINANCIAL INFORMATION