Plaintiff’s name, address, and telephone no. 

 moving party

Defendant’s name, address, and telephone no. 

 moving party

Third party name, address, and telephone no. 

 moving party

v

  1. Friend of the court records show that, as of 
C

Date

 :

  a. my current support is $ 

 per month. My youngest child in the case will be or was 18 years of age on

  b. my total arrears are $ 

 . Attached is written proof from the friend of the court office.

 , the individual payee.

 

 .

 

   

Date

  c.  I owe $ 
 

  d. I owe $ 
 

  e. I owe $ 
 

  f.   I owe $ 
 

  g. I owe $ 
 

 support arrears to 

Name

 support arrears to the State of Michigan.

 for Medicaid/confinement reimbursement arrears.

 in statutory fees.

 to 

Specify agency/person

 .

2. It is in the best interests of the parties and the child(ren) that a payment plan be ordered in this case.

 3. I understand that the individual payee must consent to entry of an order for payment plan when the arrears are owed 

        to that individual. The payee’s consent was not given under fear, coercion, or duress.

 4. I owe arrears to the State of Michigan or a political subdivision and, absent a payment plan, I do not have the present 

        ability and will not have the ability in the foreseeable future to pay the arrears.

  5. I did not engage in conduct exclusively for the purpose of avoiding my support obligation.

  6. I have gross income in the amount of $ 
 
 

    to show proof of my income.

 per 
 

 . I understand that I must provide adequate records

  7. I have assests, solely or jointly owned, as of this date, as follows: (assests include but are not limited to vehicles, real
 

    estate, bank accounts, retirement accounts, trust funds, etc.) Continue on page 2 and attach a separate sheet if more space is needed.

Description

a.

b.

c.

Net Value

$

$

$

(See page 2 for remainder of motion.)

B

 

 

 

 

 

 

 

 

   

ED

 
 

 
 

GF

FOC 109 (6/17) MOTION REGARDING PAYMENT PLAN/DISCHARGE OF ARREARSMCL 552.605eAApproved, SCAO Original - Court1st copy - Other party2nd copy - Moving party3rd copy - Friend of the court4th copy - Proof of service5th copy - Proof of serviceSTATE OF MICHIGANJUDICIAL CIRCUITCOUNTY MOTION REGARDING PAYMENT PLAN/DISCHARGE OF ARREARSCASE NO.Court addressCourt telephone no.Motion Regarding Payment Plan/Discharge of Arrears 

(6/17)  Page 

  

 of 

  

Case No. 
 

  7. (continued.)  Attach a separate sheet if more space is needed.

Description

Net Value

$

$

$

$

$

$

d.

e.

f.

g.

h.

i.

 
 
 

 

I

Date

  8. If arrears are owed to the State of Michigan, I will provide notice to the Office of Child Support at least 56 days before the 
 

    hearing on this matter.

  9. I ask:
H
 
 

    a. that the court order a payment plan of $ 
 
        case.

 per month for 
 

 months toward support arrears in this

    b. that if the court declines to order the payment plan as requested above, the court order a payment plan of support 
        arrears as found by the court to be a reasonable monthly payment over a reasonable time in accordance with my ability 
        to pay.

    c.  that the court grant me such other and further relief as is just and appropriate.

  10. I further ask that once I complete this payment plan, the court enter an order discharging any remaining arrears.

Signature

NOTICE OF HEARING

  A hearing will be held on this motion before 
J
  on  
 
If you require special accommodations to use the court because of a disability, or if you require a foreign language interpreter 
to help you fully participate in court proceedings, please contact the court immediately to make arrangements. When 
contacting the court, provide your case number(s).

Judge/Referee                                                                                                                          Bar no.

Date
         

Location

Time

 at 

 at 

 . 

Note: If you are the person receiving this motion, you may file a response. Contact the friend of the court office and request form FOC 117.

 
I certify that on this date I served a copy of this motion on the parties or their attorneys and as appropriate to the Office of
K
  Child Support or political subdivision by first-class mail addressed to their last-known addresses as defined in MCR 3.203.

CERTIFICATE OF MAILING

Date

Signature