A

v

C
      Date:    
 
Judge: 
 
 
 
 
 
 

Plaintiff’s name, address, and telephone no.                   

Defendant’s name, address, and telephone no. 

B

Third party’s name, address, and telephone no.

 

D

E

1. This order is prepared 
                                    
 
 
                               
THE COURT FINDS:

 a. after hearing. 
 b. on consent/stipulation of the parties. 

 

 

 

 

 

 

 

 

 2. A request for establishment of custody, parenting time, and support was filed on 

 3. A motion requesting a change in custody, parenting time, and support was filed on 

Date

Date

 .

 .

   
   
   

 a. A change of circumstances 
 b. Proper cause 
 c.  A substantial change of circumstances exists that warrants modification of the support order.

 does not  exist that warrants a review of custody or parenting time.

 does not  exist that warrants a review of custody or parenting time.

 does 

 does 

 4. A response was filed on 

 .

Date

 5. It 
   

 
 is 
 custody 

 is not 
 parenting time.

in the best interests of the child(ren) to 

 

 establish 

 

 change 

 

 6. It is in the best interests of the child(ren) to dismiss the motion.

IT IS ORDERED:

 7. The motion regarding custody, parenting time, and support is dismissed. The prior order remains in effect.

 8. Custody is 

 

 established 

 

 changed 

  as follows: 

 

  

     Name(s) of child(ren): 
 
 Joint legal to 
 
 
 
 
 
 

 Joint physical to 
 Sole legal to 
 Sole physical to 
 Other (specify):

    Unless otherwise agreed, a parent whose custody or parenting time of a child is governed by this order shall 
  not change the legal residence of the child except in compliance with MCL 722.31.

 plaintiff. 

 defendant.  

 third party.

 plaintiff. 
 plaintiff. 
 plaintiff. 

 defendant.  
 defendant.  
 defendant.  

 third party.
 third party.
 third party.

 
 
 

 

 
 
 
 
 
 
 
 

Approved, SCAO
Form FOC 89, Rev. 3/23
MCL 552.517b(8), MCL 552.519(3)(k)(i), MCL 722.21 et seq., MCR 2.119 
Page 1 of 3

Distribute form to: 
Court 
Other party 
Moving party 
Friend of the court
Proof of service

STATE OF MICHIGANJUDICIAL CIRCUITCOUNTYORDER REGARDING CUSTODY AND PARENTING TIMECASE NO. and JUDGECourt addressCourt telephone no.Order Regarding Custody and Parenting Time 
Page 2 of 3

(3/23) 

Case No. 
 

9. Parenting time is 
 established 
    Explain in detail what the court has ordered.

 

 

 changed 

  as follows:

10.  The parents shall cooperate with respect to a child so as, in a maximum degree, to advance a child’s health, 
  emotional, and physical well-being and to give and afford a child the affection of both parents and a sense of 
 
  security. Neither parent will, directly or indirectly, influence a child so as to prejudice a child against the other parent. 
 
  Each parent will endeavor to guide a child so as to promote the affectionate relationship between a child and the 
 
  other parent. The parties will cooperate with each other in carrying out the provisions of this order for a child’s best 
 
  interests. Whenever it seems necessary to adjust, vary, or increase the time allotted to either party, or otherwise 
 
  take action regarding a child, each of the parties shall act in the best interests of the child. Neither party shall do 
 
  anything which may estrange the other from the child, injure the child’s opinion of the other party, or which will 
 
  hamper the free and natural development of the child for the other party.
 

11. The parent with primary physical custody shall notify the friend of the court in writing whenever the address of a 
  minor child changes. The domicile of the minor child may not be moved from the State of Michigan without prior 
 
  approval of the court.
 

 12. The Uniform Child Support Order is incorporated by reference (form FOC 10/52 or FOC 10a/52a).

13.  Except as provided in item 14, neither parent shall exercise parenting time in a foreign country/nation that is not a 
 

  party to the Hague Convention on the Civil Aspects of International Child Abduction.

Order Regarding Custody and Parenting Time 
Page 3 of 3

(3/23) 

Case No. 
 

 14. Based on written agreement of the parties, 

Name

      exercise parenting time in 

Name of foreign country/nation

      Convention on the Civil Aspects of International Child Abduction.

 

 

 may 

 , which is not a party to the Hague 

Plaintiff (if consent/stipulation)                                                    Date

Defendant (if consent/stipulation)                                                             Date

 

     

      

Plaintiff’s attorney                                                                       Date

Defendant’s attorney                                                                                 Date

Prepared by: 

Name (type or print)

 

                                                                                      Judge signature and date

CERTIFICATE OF MAILING

I served a copy of this order on the parties or their attorneys by first-class mail addressed to their last-known addresses 
as defined by MCR 3.203. I declare under the penalties of perjury that this certificate of mailing has been examined by 
me and that its contents are true to the best of my information, knowledge, and belief.

Date

                                                   

Signature