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Here is the text we could read:

Approved,  SCAO

STATE OF MICHIGAN

Court  address

FINANCIAL STATEMENT

PERSONAL INFORMATION

CASE NO.

Court  telephone  no.

Name (last, first, middle)

Date of birth

SSN (last 4 digits)

Address

house

apartment

lot no.

City

Zip

Home phone no.

     Work phone no.               Cellular phone no.

     Driver's license no.                   State           E-mail address

Mailing  address  (if  different  than  above)

 Marital status

Single

   Married          Separated           Widowed

Name and address of nearest living relative

 Relationship

Phone no.

Divorced                    If divorced, date final

Names of dependents

 Dates of birth            Student (Yes/No)             College/University

Employer 1 (Company name and address)

Employer 2 (Company name and address)

If  self-employed,  type  of  business/trade

If  unemployed,  source  of  support

General assistance          SSI

Have  you  ever  filed  for  bankruptcy?

     Yes

      No

If yes, date filed

Date completed

           Length of employment

           Length of employment

Food stamps

         AFDC

Vehicle  #1

Vehicle  #2

ASSETS

Year / Make

Year / Make

Bank/Financial account no.

Name and address of financial institution

Investment/Brokerage  account  no.

Name and address of financial institution

Other  property  such  as  real  estate,  boats,  snowmobiles  (describe)

Present value

Present value

Present balance

Present balance

Value

$

$

$

$

$

MONTHLY INCOME

Gross  monthly  income  (self)

Gross  monthly  income  (spouse)

Unemployment benefits

Social  security

Retirement/Pension benefits

Child support

Alimony/Maintenance

Disability

Veteran's  benefits

Interest/Dividends

Other  (cash):

$

$

$

$

$

$

$

$

$

$

$

TOTAL ASSETS $

MONTHLY EXPENSES

Insurance  (vehicle/health/life)

Mortgage or rent

Utilities

Vehicle  payments

Other loan payments

Child support/Alimony

Medical payments

Court payments

Other:

$

$

$

$

$

$

$

$

$

TOTAL INCOME $

             TOTAL EXPENSES $

Financial Report Authorization:  I authorize the court, the court's funding unit, and their employees or agents to obtain a consumer
 
 credit report and other financial information about me from a consumer credit reporting agency or any other entity.

I certify under penalty of perjury that this financial statement is a complete and accurate statement of my income, assets, and
expenses, and that I have no other additional income.  I will provide supporting documentation of income and debts upon request.

Date
MC 287   (3/09)   FINANCIAL STATEMENT

Signature

Financial Statement

This info page is part of the LIT Lab's Form Explorer project. It is not associated with the Michigan state courts. To learn more about the project, check out our about page.

Downloads: You can download both the original form (last checked 2023-03) and the machine-processed form with normalized data fields.

About This Form:

Sourced from www.courts.michigan.gov/Collections-Forms (2023-03)
Page(s): 1
Fields(s): 83
Average fields per page: 83
Reading Level: Grade 9
LIST Grouping(s): MO-00-00-00-00.

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Identified Data Fields:

We have done our best to automaticly identify and name form fields according to our naming conventions. When possible, we've used names tied to our question library. See e.g., user1_name. If we think we've found a match to a question in our library, it is highlighted in green. Novel names are auto generated. So, you will probably need to edit some of them if you're trying to stick to the convention.

Here are the fields we could identify.

cas_e was CASE NO (0.63 conf)
name_last_first_middle was Name last first middle (0.34 conf)
ss_n_last_digits was SSN last 4 digits (0.35 conf)
house was house (0.37 conf)
apartment was apartment (0.47 conf)
lot was lot no (0.45 conf)
users1_address_city was City (1.00 conf)
home_phone was Home phone no (0.44 conf)
work_phone was Work phone no (0.38 conf)
cellular_phone was Cellular phone no (0.32 conf)
drivers_license was Drivers license no (0.53 conf)
users1_address_state was State (1.00 conf)
mailing_address_different was Mailing address if different than above (0.38 conf)
single was Single (0.32 conf)
married was Married (0.36 conf)
separated was Separated (0.31 conf)
widowed was Widowed (0.36 conf)
divorced was Divorced (0.44 conf)
divorced_date_final was If divorced date final (0.45 conf)
nearest_living_relative was Name and address of nearest living relative (0.32 conf)
relationship was Relationship (0.39 conf)
names_dependents was Names of dependents (0.44 conf)
dates_birth_row was Dates of birthRow1 (0.40 conf)
student_yes_row was Student YesNoRow1 (0.43 conf)
college_university_row was CollegeUniversityRow1 (0.33 conf)
employer_company_address was Employer 1 Company name and address (0.36 conf)
length_employment was Length of employment (0.41 conf)
selfemployed_type was If selfemployed type of businesstrade (0.42 conf)
general_assistance was General assistance (0.44 conf)
ssi was SSI (0.45 conf)
afdc was AFDC (0.35 conf)
vehicle_year_make__1 was Vehicle 1 Year Make (0.32 conf)
present_value__1 was Present value (0.38 conf)
vehicle_year_make__2 was Vehicle 2 Year Make (0.32 conf)
present_value__2 was Present value_2 (0.37 conf)
bank_financial_account was BankFinancial account no (0.50 conf)
address_financial_institution__1 was Name and address of financial institution (0.45 conf)
address_financial_institution__2 was Name and address of financial institution_2 (0.38 conf)
fill was fill_8 (0.36 conf)
expenses_income_request was expenses and that I have no other additional income I will provide supporting documentation of income and debts upon request (0.41 conf)
text__1 was Text10 (0.35 conf)
text__2 was Text11 (0.35 conf)
text__3 was Text12 (0.35 conf)
text__4 was Text13 (0.35 conf)
text__5 was Text14 (0.35 conf)
text__6 was Text15 (0.35 conf)
text__7 was Text16 (0.35 conf)
text__8 was Text17 (0.35 conf)
text__9 was Text18 (0.35 conf)
text__10 was Text19 (0.35 conf)
text__11 was Text20 (0.35 conf)
text__12 was Text21 (0.35 conf)
text__13 was Text22 (0.35 conf)
text__14 was Text23 (0.35 conf)
text__15 was Text24 (0.35 conf)
text__16 was Text25 (0.35 conf)
text__17 was Text26 (0.35 conf)
text__18 was Text27 (0.35 conf)
text__19 was Text28 (0.35 conf)
text__20 was Text29 (0.35 conf)
text__21 was Text30 (0.35 conf)
text__22 was Text31 (0.35 conf)
text__23 was Text32 (0.35 conf)
text__24 was Text33 (0.35 conf)
text__25 was Text34 (0.35 conf)
text__26 was Text35 (0.35 conf)
text__27 was Text36 (0.35 conf)
text__28 was Text37 (0.35 conf)
text__29 was Text38 (0.35 conf)
text__30 was Text39 (0.35 conf)
text__31 was Text40 (0.35 conf)
text__32 was Text41 (0.35 conf)
text__33 was Text42 (0.35 conf)
text__34 was Text43 (0.35 conf)
text__35 was Text44 (0.35 conf)
text__36 was Text45 (0.35 conf)
text__37 was Text46 (0.35 conf)
text__38 was Text47 (0.35 conf)
text__39 was Text48 (0.35 conf)
text__40 was Text49 (0.35 conf)
bruptcy__1 was bruptcy1 (0.35 conf)
food_stamps was Food stamps (0.32 conf)
bruptcy__2 was bruptcy2 (0.35 conf)

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The Legal Innovation & Technology Lab's Form Explorer Beta @ Suffolk Law School Last updated 2023-04-02

Financial Statement

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Identified Data Fields:

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The Legal Innovation & Technology Lab's Form Explorer ^Beta @ Suffolk Law School Last updated 2023-04-02