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

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Here is the text we could read:

Approved, SCAO

STATE OF MICHIGAN

JUDICIAL CIRCUIT - FAMILY DIVISION
COUNTY

Court address

1. In the matter of

(name(s), alias(es), DOB)

FINANCIAL STATEMENT

CASE NO.
PETITION NO.

Court telephone no.

1. Name

2. Date of birth

10. Spouse

11. Date or birth

3. Soc. sec. no.

4. Driver license no.

12. Soc. sec. no.

13. Driver license no.

5. Employer's name

7. Employer's address

6. Length of

employment

14. Employer's name

16. Employer's address

15. Length of

employment

8. Gross pay

9. List payroll deductions from amount at left

17. Gross pay 18. List payroll deductions from amount at left

Federal inc. tax

State inc. tax

Local inc. tax

Federal inc. tax

State inc. tax

Local inc. tax

FICA

Other:

per

FICA

Other:

(attach W-2)

20. Telephone no.

21. Marital status

22. Names and ages of dependents residing with petitioner

23. Names, ages, and relationships of all other people living in the home

per

(attach W-2)

19. Home address

single

married

separated

divorced

PERSONAL & EMPLOYMENT INFORMATION

24. MEDICAL/MEDICAID/DENTAL/OPTICAL INSURANCES List company name and policy no., and whether group, co-deductible, etc.

25. OTHER INCOME List below all other income, including: overtime,

26. ASSETS (other than real estate and motor vehicles)

tips, public assistance, child support, unemployment, veteran's benefits,

List all other assets below, including: checking and savings accounts,

social security, pensions, workers comp., disability, interest, dividends,

stocks, bonds, insurance cash value, IRA's, deferred compensation,

rent, etc.

SOURCE OF INCOME

retirement funds, bond posted, etc.

BALANCE

INSTITUTION NAME

per

Checking/Draft

Savings

Credit Union

ASSET

VALUE

PLEASE CONTINUE ON OTHER SIDE IF NECESSARY (Item 29)

27.PROPERTY

REAL ESTATE

MOTOR VEHICLES

Purchase Price

Current Value

Loan Balance

Payments

Year

Make

Loan Balance

Payments

JC 34 (6/03) FINANCIAL STATEMENT

PLEASE CONTINUE ON OTHER SIDE

28.OTHER PAYMENTS

(Do not include payroll deductions listed in items 9 and 18 or property payments listed in item 27)

List all other payments, including: rent, utilities, support, loans, garnishments, mandatory union dues, mandatory retirement contributions, etc.

ITEM

PAYMENT

BALANCE

ITEM

PAYMENT

BALANCE

per

29. EXTRA SPACE

Use this space if you ran out of room above. Please label your items as INCOME, ASSETS, PROPERTY, PAYMENTS, etc.

PLEASE CONTINUE BELOW IF NECESSARY

30.Attach a copy of last year's Federal Income Tax Return.

I declare that this financial statement has been examined by me and that its contents are true to the best of my information, knowledge,
and belief. I further authorize the release of any information needed to verify this statement or any other information needed to verify
my financial affairs.

I understand that if I knowingly list any false information on this financial statement, I may be found in contempt of court.

Date

Signature

REVIEW AND RECOMMENDATIONS:

Relationship to child(ren)

FOR COURT USE ONLY

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): 2
Fields(s): 179
Average fields per page: 89
Reading Level: Grade 10
LIST Grouping(s): MO-00-00-00-00, MO-09-00-00-00.

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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.

docket_number was caseno (1.00 conf)
petno was petno (0.35 conf)
ctno was ctno (0.35 conf)
ctaddress was ctaddress (0.35 conf)
cirno was cirno (0.38 conf)
county was county (0.39 conf)
casename was casename (0.35 conf)
name__1 was name1 (0.35 conf)
dob__1 was dob1 (0.35 conf)
ssn__1 was ssn1 (0.35 conf)
dln__1 was dln1 (0.35 conf)
employer__1 was employer1 (0.35 conf)
time__1 was time1 (0.37 conf)
empaddress__1 was empaddress1 (0.35 conf)
frequency__1 was frequency1 (0.35 conf)
fedtax__1 was fedtax1 (0.35 conf)
statetax__1 was statetax1 (0.35 conf)
loctax__1 was loctax1 (0.35 conf)
fica__1 was fica1 (0.35 conf)
other1 was other1 (0.35 conf)
othera__1 was othera1 (0.35 conf)
name__2 was name2 (0.44 conf)
dob__2 was dob2 (0.35 conf)
ssn__2 was ssn2 (0.35 conf)
dln__2 was dln2 (0.35 conf)
employer__2 was employer2 (0.35 conf)
time__2 was time2 (0.35 conf)
empaddress__2 was empaddress2 (0.35 conf)
frequency__2 was frequency2 (0.35 conf)
fedtax__2 was fedtax2 (0.35 conf)
statetax__2 was statetax2 (0.35 conf)
loctax__2 was loctax2 (0.35 conf)
fica__2 was fica2 (0.35 conf)
other2 was other2 (0.35 conf)
othera__2 was othera2 (0.35 conf)
haddress was haddress (0.35 conf)
telno was telno (0.35 conf)
dependents was dependents (0.41 conf)
others was others (0.36 conf)
medicalinfo was medicalinfo (0.35 conf)
income__1 was income1 (0.35 conf)
amt__1 was amt1 (0.35 conf)
often__1 was often1 (0.35 conf)
income__2 was income2 (0.35 conf)
amt__2 was amt2 (0.35 conf)
often__2 was often2 (0.35 conf)
income__3 was income3 (0.35 conf)
amt__3 was amt3 (0.35 conf)
often__3 was often3 (0.35 conf)
income__4 was income4 (0.35 conf)
amt__4 was amt4 (0.35 conf)
often__4 was often4 (0.35 conf)
income__5 was income5 (0.35 conf)
amt__5 was amt5 (0.35 conf)
often__5 was often5 (0.35 conf)
income__6 was income6 (0.35 conf)
amt__6 was amt6 (0.35 conf)
often__6 was often6 (0.35 conf)
income__7 was income7 (0.35 conf)
amt__7 was amt7 (0.35 conf)
often__7 was often7 (0.35 conf)
income__8 was income8 (0.35 conf)
amt__8 was amt8 (0.35 conf)
often__8 was often8 (0.35 conf)
income__9 was income9 (0.35 conf)
amt__9 was amt9 (0.35 conf)
often__9 was often9 (0.35 conf)
check was check (0.37 conf)
instname__1 was instname1 (0.35 conf)
savings was savings (0.37 conf)
instname__2 was instname2 (0.35 conf)
credit was credit (0.37 conf)
instname__3 was instname3 (0.35 conf)
asset__1 was asset1 (0.35 conf)
value__1 was value1 (0.35 conf)
asset__2 was asset2 (0.35 conf)
value__2 was value2 (0.34 conf)
asset__3 was asset3 (0.35 conf)
value__3 was value3 (0.35 conf)
asset__4 was asset4 (0.35 conf)
value__4 was value4 (0.35 conf)
asset__5 was asset5 (0.35 conf)
value__5 was value5 (0.35 conf)
purprice__1 was purprice (0.35 conf)
currentval__1 was currentval (0.35 conf)
balance__1 was balance (0.38 conf)
payment__1 was payment (0.42 conf)
purprice__2 was purprice1 (0.35 conf)
currentval__2 was currentval1 (0.35 conf)
balance__2 was balance1 (0.35 conf)
payment__2 was payment1 (0.35 conf)
year__1 was year (0.28 conf)
make__1 was make (0.39 conf)
balance__3 was balance2 (0.35 conf)
payment__3 was payment2 (0.35 conf)
year__2 was year1 (0.35 conf)
make__2 was make1 (0.35 conf)
balance__4 was balance3 (0.35 conf)
payment__4 was payment3 (0.35 conf)
pay__1 was pay1 (0.35 conf)
pay__2 was pay2 (0.35 conf)
check_box__1 was Check Box1 (0.52 conf)
check_box__2 was Check Box3 (0.37 conf)
check_box__3 was Check Box2 (0.37 conf)
check_box__4 was Check Box4 (0.37 conf)
item__1 was item1 (0.43 conf)
item__2 was item2 (0.40 conf)
per__1 was per2 (0.35 conf)
bal__1 was bal2 (0.35 conf)
item__3 was item3 (0.35 conf)
pay__3 was pay3 (0.35 conf)
per__2 was per3 (0.35 conf)
bal__2 was bal3 (0.35 conf)
item__4 was item4 (0.35 conf)
pay__4 was pay4 (0.35 conf)
per__3 was per4 (0.35 conf)
bal__3 was bal4 (0.35 conf)
item__5 was item5 (0.35 conf)
pay__5 was pay5 (0.35 conf)
per__4 was per5 (0.35 conf)
bal__4 was bal5 (0.35 conf)
item__6 was item6 (0.35 conf)
pay__6 was pay6 (0.35 conf)
per__5 was per6 (0.35 conf)
bal__5 was bal6 (0.35 conf)
item__7 was item7 (0.35 conf)
pay__7 was pay7 (0.35 conf)
per__6 was per7 (0.35 conf)
bal__6 was bal7 (0.35 conf)
item__8 was item8 (0.35 conf)
pay__8 was pay8 (0.35 conf)
per__7 was per1 (0.35 conf)
bal__7 was bal1 (0.35 conf)
item__9 was item9 (0.35 conf)
pay__9 was pay9 (0.35 conf)
per__8 was per9 (0.35 conf)
bal__8 was bal9 (0.35 conf)
item__10 was item10 (0.35 conf)
pay__10 was pay10 (0.35 conf)
per__9 was per10 (0.35 conf)
bal__9 was bal10 (0.35 conf)
item__11 was item11 (0.35 conf)
pay__11 was pay11 (0.35 conf)
per__10 was per11 (0.35 conf)
bal__10 was bal11 (0.35 conf)
item__12 was item12 (0.35 conf)
pay__12 was pay12 (0.35 conf)
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bal__11 was bal12 (0.35 conf)
item__13 was item13 (0.35 conf)
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item__14 was item14 (0.35 conf)
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bal__13 was bal14 (0.35 conf)
more1 was more1 (0.35 conf)
more2 was more2 (0.35 conf)
more3 was more3 (0.35 conf)
more4 was more4 (0.34 conf)
more5 was more5 (0.35 conf)
more6 was more6 (0.35 conf)
more7 was more7 (0.35 conf)
more8 was more8 (0.35 conf)
more9 was more9 (0.35 conf)
more10 was more10 (0.35 conf)
more11 was more11 (0.35 conf)
more12 was more12 (0.35 conf)
more13 was more13 (0.35 conf)
more14 was more14 (0.35 conf)
signature_date__1 was date1 (1.00 conf)
relation__1 was relation1 (0.35 conf)
signature_date__2 was date2 (1.00 conf)
relation__2 was relation2 (0.35 conf)
pay__15 was pay100 (0.35 conf)
pay__16 was pay200 (0.35 conf)
per__14 was per100 (0.35 conf)
bal__14 was bal100 (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

About This Form:

Identified Data Fields:

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