Wage Assignment {MC 289}

Approved, SCAO Original - Court 1st copy - Employee 2nd copy - Employer STATE OF MICHIGAN JUDICIAL DISTRICT JUDICIAL CIRCUIT Court address CASE NO. WAGE ASSIGNMENT Court telephone no. In the matter of Address Name of employee City Last four digits of social security no. or employee ID no. State Zip Date of birth Telephone no. 1. The defendant is on probation and missed two or more regularly scheduled restitution payments and has signed the voluntary agreement below: I agree to the assignment of my wages to pay my financial obligations to the court. I understand that the court may collect my financial obligations until paid in full. Date Signature of defendant OR 2. This order is issued under MCL 769.1k. IT IS ORDERED: 3. Employer's name Employer's address shall withhold from the earnings due to the person named above the amount of $ per , effective one week after service upon the employer of a copy of this order. The employer shall indicate the case number on the withholding and shall forward the withholding to the court at the above address. 4. The employer shall not use this assignment as a basis, in whole or in part, for the discharge of the employee or for any other disciplinary action against the employee. 5. Your compliance with this order is required by law. 6. This order shall remain in full force and effect until further order of the court or until the total of $ Most recent balance been withheld, whichever comes first. Date Judge has Bar no. Note: Wage assignment is a transfer of the right to receive wages, ordinarily effected by means of a contract. As such, wage assignments are not within the scope of the federal wage garnishment law. For purposes of this order, however, wages have been defined based on the federal wage garnishment law. Wages are defined as earnings or compensation paid for personal services whether called wages, salary, commission, bonus, or otherwise, and can include periodic payments under a pension or retirement program. (Title III, Section 302, PL 90-321) When required, withholdings shall be determined using the calculation sheet from SCAO-Approved form MC 14 (Garnishee Disclosure). CERTIFICATE OF MAILING I certify that on this date I served a copy of this wage assignment on the employee and employer by first-class mail addressed to their last-known addresses as defined by MCR 2.107(C)(3). Date MC 289 (6/17) Signature WAGE ASSIGNMENT American LegalNet, Inc. www.FormsWorkFlow.com MCL 769.1K, MCL 771.3(2)(f), MCL 780.766(18), MCL 780.794(18), MCL 780.826(15)