STATE OF MICHIGAN

JUDICIAL CIRCUIT
COUNTY

UNIFORM CHILD SUPPORT ORDER,
NO FRIEND OF THE COURT SERVICES
 TEMPORARY
   
 
 FINAL 
   

 EX PARTE 
 
 MODIFICATION 

 

 

 

CASE NO. and JUDGE

 

This order is entered 
   
An order exempting this case from friend of the court services was entered on 
(NOTE: If there is no order exempting this case from friend of the court services, form FOC 10/52 must be used.)

 on stipulation/consent of the parties. 

 after hearing. 

 

 

 . 

 

IT IS ORDERED, unless otherwise ordered in item 8 or 9: 

 

 Standard provisions have been modified (see item 8 or 9).

1. The children who are supported under this order and the payer and payee are:   

Payer:

Payee:

Children’s names and annual overnights with payer:

Children’s names

Overnights

Effective 
 

 , the payer shall pay a monthly child support obligation for the children named above.

Court telephone no.Court addressPlaintiff’s name, address, and telephone no.vDefendant’s name, address, and telephone no.Plaintiff’s attorney, bar no., address, and telephone no.Defendant’s attorney, bar no., address, and telephone no.Plaintiff’s source of income name, address, and telephone no.Defendant’s source of income name, address, and telephone no.Approved, SCAOForm FOC 10a/52a, Rev. 7/21MCL 552.14, MCL 552.517, MCL 552.517b(3), MCR 3.211Page 1 of 3Distribute form to: Court PlaintiffDefendantFriend of the courtUniform Child Support Order, No FOC Services 
Page 2 of 3

(7/21) 

Case No. 
 

1. Item 1 (continued).

1 child

2 children

3 children

Children supported:
Base Support: (includes support plus or minus premium adjustment for health-care insurance)
  Support:
  Premium adjust:
  Subtotal:
Ordinary medical:
Child care:
Other:
Benefit credit:
Total:

$
$
$
$
$
$
$
$
 Support was reduced because payer’s income was reduced.

$
$
$
$
$
$
$
$

$
$
$
$
$
$
$
$

$
$
$
$
$
$
$
$

$
$
$
$
$
$
$
$

4 children

5 or more children

Uninsured Health-Care Expenses. All uninsured health-care expenses exceeding the annual ordinary medical amount 
will be paid  
 % by the defendant. Uninsured expenses exceeding the annual 
ordinary medical amount for the year they are incurred that are not paid within 28 days of a written payment request may 
 .
be enforced by the friend of the court. The annual ordinary medical amount is 
 

 % by the plaintiff and  

 

 

  Obligation Ends. Except for child care, or as otherwise ordered, support obligations for each child end on the last day  
 
  of the month the child turns age 18.  

 

 Post-majority Support: The following children will be attending high school on a full-time basis after turning 18    
 

   
        years of age. Therefore, the support obligation for each specific child ends on the last day of the month as  
        follows, except in no case may it extend beyond the time the child reaches 19 years and 6 months of age: 
        (Specify name of child and date obligation ends.) 
       

 

 
 
 
 
 

 

 

 

       

 

  Child Care. The parties must notify each other of changes in child-care expenses and must additionally notify the  
friend of the court if the changes end those expenses. The child-care obligation for each child ends on August 31  
 
 
following the child’s 12th birthday, at which time the total child care obligation reduces by that child’s pro rata share  
  unless specified differently in this order.
 
 defendant  shall maintain health-care 
2. Health-Care Coverage.  For the benefit of the children, the 
  coverage (as defined in MCL 552.602) that includes payment for hospital, dental, optical, and other health-care expenses 
  when that coverage is accessible to the child and available at a reasonable cost. The reasonable cost is the parent’s 
  net cost of adding the children to the parent’s coverage
 
 

 up to a maximum of $ 
 
 not to exceed 6% of the plaintiff’s/defendant’s gross income.  

 up to a maximum of $ 
 

 for defendant.

 for plaintiff. 

 plaintiff 

 

 

 

 

 
 
 

 3. Qualified Medical Support Order.  This order is a qualified medical support order with immediate effect pursuant    
    to 29 USC 1169.  Further details, as prescribed by 29 USC 1169(a) (3), are stated in item 9.

 

 
4.  Retroactive Modification and Liens for Unpaid Support.  Except as provided by MCL 552.603, support is a  
 
 
judgment the date it is due and is not modifiable retroactively.  Unpaid support is a lien by operation of law and the  
  payer's property can be encumbered or seized if an arrearage accrues in an amount greater than the periodic support   
  payments payable for two months under the payer's support order. 

 
 
 
insurance coverage, persons insured, or contract numbers; d) their occupational or driver’s licenses; and e) their social  

5. Change of Address, Employment Status, Health Insurance.  Both parties shall notify each other in writing, within  
  21 days of any change in:  a) their mailing and residential addresses and telephone numbers; b) the names,  
  addresses, and telephone numbers of their sources of income; c) their health-maintenance or insurance companies,  
 
  security numbers unless exempt by law pursuant to MCL 552.603.   

 

Uniform Child Support Order, No FOC Services 
Page 3 of 3
6. Foster-Care Assignment. When a child is placed in foster care, that child's support is assigned to the Michigan 
  Department of Health and Human Services while under the state's jurisdiction and to the funding county while placed in 
  a county-funded program.

Case No. 
 

(7/21) 

7. Abatement. If the payer will be incarcerated for 180 consecutive days or more and will not have the ability to pay 
  support, the monthly amount of support payable under the order must be abated, by operation of law, subject to 
  section 17f of the friend of the court act, MCL 552.517f.

 8. Michigan Child Support Formula Deviation. The support provisions ordered do not follow the Michigan Child 
    Support Formula. The attached deviation addendum (FOC 10d) provides the basis for deviation and the required  
    findings by the court.

 
 

 
 

  9. Other:  (Attach separate sheets as needed.)

10.  Prior Orders. This order supersedes all prior child support orders and all continuing provisions are restated 
 

  in  this order. Past-due amounts owed under any prior support order in this case are preserved.

 

                     

Judge signature and date

Plaintiff (if consent/stipulation)                                                              Date

Defendant (if consent/stipulation)                                                             Date

Plaintiff’s attorney                                                                                 Date

Defendant’s attorney                                                                                Date

 

 

Prepared by: 

Name (type or print)

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 certify that I also served the Deviation Addendum (FOC 10d) with this order. 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