Approved, SCAO

STATE OF MICHIGAN

JUDICIAL CIRCUIT
COUNTY

FINDINGS AND REPORT ON
ARREARAGE PAYMENT AMOUNT

Original - Court
1st copy - Payer
2nd copy - Payee
3rd copy - Friend of the court
CASE NO.

Court  address

Court  telephone  no.

Plaintiff's name and address

1.

a. Based on an administrative action taken on

v

Defendant's name and address

Date

Date

b. After an administrative hearing held on

      before

Friend of the court/Referee/Other

Bar no.

the friend of the court office determines:

2. Application of arrearage guidelines

is

is not

 unjust or inappropriate.

3. There
4. There

has
has

has not
has not

been a mistake of fact regarding the payer's identity.
been a mistake of fact regarding the amount of current support or arrears as follows:

5. The specific amounts that the payer should be required to pay for current and past-due support, confinement, and fees are:

6.The prior total payment amount deviates from the arrearage guideline and an alternate total payment amount
be set because circumstances

should not

have not

should

have

changed sufficiently

as follows:

a. The arrearage and confinement payment amounts determined by application of the arrearage guideline and the factual

assumptions or findings upon which this amount is based are:

b. The alternate payment amount and the factual assumptions upon which the amount is based are:

The alternate payment amount

is

is not

contrary to the best interests of child.

c. The alternate  payment amount deviates from the arrearage guideline and was calculated as follows:

d. The reasons for the alternate payment amount are:

e. Other evidence that the individual

is

is not

able to make the alternate payment amount is attached.

f. The impact of the alternate payment amount is as follows:

7. NOTICE TO PAYER:  You have the right to request a judicial hearing on the record appealing the determination of the

administrative review hearing.

Based upon these findings, entry of the attached income withholding order is recommended.

Date

Referee/Friend of the court signature

FOC 95   (5/10)   FINDINGS AND REPORT ON ARREARAGE PAYMENT AMOUNT