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Here is the text we could read:

Approved, SCAO

STATE OF MICHIGAN

JUDICIAL CIRCUIT - FAMILY DIVISION
COUNTY

In the matter of

Full name of child

SUPPLEMENT TO PETITIONER'S
VERIFIED ACCOUNTING

JIS CODE: PCS and MiCOURT - SPV

TCS - PV21

FILE NO.

Additional payments/disbursements of money or anything of value made or agreed to be made by me or on my behalf were made
in connection with this adoption after form PCA 347 was filed with the court.
No further payments/disbursements of money or anything of value made or agreed to be made by me or on my behalf were made
in connection with this adoption since I filed form PCA 347 with the court.

EXPENSES

TOTAL

DOB:

, adoptee

1. Court Filing Fee

Order of Adoption...................................................................................................... $
Motion for Early Confirmation .................................................................................... $
Birth Certificate Fee .................................................................................................. $
Other petitions, motions, orders ................................................................................ $

2. Agency/Michigan Department of Health and Human Services Charges (itemized on other side of this form)

3. Attorney Fees (itemized on other side of this form) ..................................................................................

4. Travel Expenses (itemized on other side of this form) ..............................................................................

5. Medical, Hospital, Nursing, or Pharmaceutical Expenses (itemized on other side of this form) ................

6. Counseling Services (itemized on other side of this form) ........................................................................

7. Living Expenses (itemized on other side of this form) ..............................................................................

8. Information Gathering Expenses (itemized on other side of this form) .....................................................

9. Other (itemized on other side of this form) .................................................................................................

10. Total of Expenses Reported on PCA 347 (this must always be completed) .........................................

I REQUEST that the court approve these payments and disbursements.

TOTAL

I declare that this accounting and the attachments have been examined by me and that the contents are true to the best of my
information, knowledge, and belief.

Date

Signature of petitioner

Name (print or type)

Address

City, state, zip

Signature of petitioner

Name (print or type)

Address

NOTE: This accounting must be filed 21 days before the final order of adoption.

Do not write below this line - For court use only

Telephone no.

City, state, zip

Telephone no.

PCA 347a (2/15) SUPPLEMENT TO PETITIONER'S VERIFIED ACCOUNTING

MCL 710.54(7), MCR 3.803(A)

ITEMIZED ACCOUNTING OF PAYMENTS/DISBURSEMENTS

Instructions: The following are types of expenses that must be itemized. Each type of expense is explained. For each type, identify
the type by number, list each expense in that type separately, total the amounts, and place the total under the same type number
on the front of this form. If the space provided below is not adequate, make copies before writing any information on this form. Write
in the date for each payment made, the amount of that payment, who that payment was made to, and the purpose of the payment
for the following types. You must attach a receipt for each payment/disbursement.
Type 2.
Type 3.
Type 4.
Type 5.

Agency Charges - fees and expenses charged by and to be paid to the agency.
Attorney Fees - fees and expenses charged by and to be paid to the attorney.
Travel Expenses - expenses associated with travel that are necessary to the adoption.
Medical Expenses - expenses connected with the birth of the child or illness of the child not covered by the birth parent's
health care benefits or Medicaid.
Counseling Expenses - expenses for counseling related to the adoption for the parent, guardian, or adoptee.
Living Expenses - expenses of the mother before the birth of the child and for no more than six weeks after the birth.
Information Gathering Expenses - expenses for getting required information about the adoptee and the adoptee's
biological family.
Other - includes copy costs, process server fees, etc.

Type 6.
Type 7.
Type 8.

Type 9.

TYPE NO.

DATE

AMOUNT

NAME AND ADDRESS OF RECIPIENT

PURPOSE

$ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $

Supplement to Petitioner's Verified Accounting

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/adoptions-court-forms (2023-03)
Page(s): 2
Fields(s): 136
Average fields per page: 68
Reading Level: Grade 8
LIST Grouping(s): MO-00-00-00-00.

Use our Rate My PDF tool to learn more. Go beyond the above insights and learn more about this or any pdf form at RateMyPDF.com, includes: counts of difficult words used, passive voice decetion, and suggestions for how to make the form more usable.

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.

cirno was cirno (0.60 conf)
county was county (0.39 conf)
docket_number was caseno (1.00 conf)
casename was casename (0.35 conf)
users1_birthdate was dob (1.00 conf)
payments was no further payments (0.42 conf)
exp__1 was exp1 (0.35 conf)
exp__2 was exp2 (0.35 conf)
exp__3 was exp3 (0.35 conf)
exp__4 was exp4 (0.35 conf)
total__1 was total1 (0.35 conf)
exp__5 was exp5 (0.35 conf)
fees was fees1 (0.35 conf)
exp__6 was exp6 (0.35 conf)
exp__7 was exp7 (0.35 conf)
exp__8 was exp8 (0.35 conf)
exp__9 was exp9 (0.35 conf)
exp__10 was exp10 (0.35 conf)
total__2 was total (0.32 conf)
exp__11 was exp11 (0.35 conf)
exp__12 was exp12 (0.35 conf)
signature_date__1 was date (1.00 conf)
pname__1 was pname1 (0.35 conf)
pname__2 was pname2 (0.35 conf)
paddress__1 was paddress1 (0.35 conf)
paddress__2 was paddress2 (0.35 conf)
pcity__1 was pcity1 (0.35 conf)
ptelno__1 was ptelno1 (0.35 conf)
pcity__2 was pcity2 (0.35 conf)
ptelno__2 was ptelno2 (0.35 conf)
check_box was Check Box1 (0.52 conf)
typeno__1 was typeno1 (0.35 conf)
signature_date__2 was date1 (1.00 conf)
amt__1 was amt1 (0.35 conf)
rec__1 was rec1 (0.35 conf)
purpose__1 was purpose1 (0.35 conf)
typeno__2 was typeno2 (0.35 conf)
signature_date__3 was date2 (1.00 conf)
amt__2 was amt2 (0.35 conf)
rec__2 was rec2 (0.35 conf)
purpose__2 was purpose2 (0.35 conf)
typeno__3 was typeno3 (0.35 conf)
signature_date__4 was date3 (1.00 conf)
amt__3 was amt3 (0.35 conf)
rec__3 was rec3 (0.35 conf)
purpose__3 was purpose3 (0.35 conf)
typeno__4 was typeno4 (0.35 conf)
signature_date__5 was date4 (1.00 conf)
amt__4 was amt4 (0.35 conf)
rec__4 was rec4 (0.35 conf)
purpose__4 was purpose4 (0.35 conf)
typeno__5 was typeno5 (0.35 conf)
signature_date__6 was date5 (1.00 conf)
amt__5 was amt5 (0.35 conf)
rec__5 was rec5 (0.35 conf)
purpose__5 was purpose5 (0.35 conf)
typeno__6 was typeno6 (0.35 conf)
signature_date__7 was date6 (1.00 conf)
amt__6 was amt6 (0.35 conf)
rec__6 was rec6 (0.35 conf)
purpose__6 was purpose6 (0.35 conf)
typeno__7 was typeno7 (0.35 conf)
signature_date__8 was date7 (1.00 conf)
amt__7 was amt7 (0.35 conf)
rec__7 was rec7 (0.35 conf)
purpose__7 was purpose7 (0.35 conf)
typeno__8 was typeno8 (0.35 conf)
signature_date__9 was date8 (1.00 conf)
amt__8 was amt8 (0.35 conf)
rec__8 was rec8 (0.35 conf)
purpose__8 was purpose8 (0.35 conf)
typeno__9 was typeno9 (0.35 conf)
signature_date__10 was date9 (1.00 conf)
amt__9 was amt9 (0.35 conf)
rec__9 was rec9 (0.35 conf)
purpose__9 was purpose9 (0.35 conf)
typeno__10 was typeno10 (0.35 conf)
signature_date__11 was date10 (1.00 conf)
amt__10 was amt10 (0.35 conf)
rec__10 was rec10 (0.35 conf)
purpose__10 was purpose10 (0.35 conf)
typeno__11 was typeno11 (0.35 conf)
signature_date__12 was date11 (1.00 conf)
amt__11 was amt11 (0.35 conf)
rec__11 was rec11 (0.35 conf)
purpose__11 was purpose11 (0.35 conf)
typeno__12 was typeno12 (0.35 conf)
signature_date__13 was date12 (1.00 conf)
amt__12 was amt12 (0.35 conf)
rec__12 was rec12 (0.35 conf)
purpose__12 was purpose12 (0.35 conf)
typeno__13 was typeno13 (0.35 conf)
signature_date__14 was date13 (1.00 conf)
amt__13 was amt13 (0.35 conf)
rec__13 was rec13 (0.35 conf)
purpose__13 was purpose13 (0.35 conf)
typeno__14 was typeno14 (0.35 conf)
signature_date__15 was date14 (1.00 conf)
amt__14 was amt14 (0.35 conf)
rec__14 was rec14 (0.35 conf)
purpose__14 was purpose14 (0.35 conf)
typeno__15 was typeno15 (0.35 conf)
signature_date__16 was date15 (1.00 conf)
amt__15 was amt15 (0.35 conf)
rec__15 was rec15 (0.35 conf)
purpose__15 was purpose15 (0.35 conf)
typeno__16 was typeno16 (0.35 conf)
signature_date__17 was date16 (1.00 conf)
amt__16 was amt16 (0.35 conf)
rec__16 was rec16 (0.35 conf)
purpose__16 was purpose16 (0.35 conf)
typeno__17 was typeno17 (0.35 conf)
signature_date__18 was date17 (1.00 conf)
amt__17 was amt17 (0.35 conf)
rec__17 was rec17 (0.35 conf)
purpose__17 was purpose17 (0.35 conf)
typeno__18 was typeno18 (0.35 conf)
signature_date__19 was date18 (1.00 conf)
amt__18 was amt18 (0.35 conf)
rec__18 was rec18 (0.35 conf)
purpose__18 was purpose18 (0.35 conf)
typeno__19 was typeno19 (0.35 conf)
signature_date__20 was date19 (1.00 conf)
amt__19 was amt19 (0.35 conf)
rec__19 was rec19 (0.35 conf)
purpose__19 was purpose19 (0.35 conf)
typeno__20 was typeno20 (0.35 conf)
signature_date__21 was date20 (1.00 conf)
amt__20 was amt20 (0.35 conf)
rec__20 was rec20 (0.35 conf)
purpose__20 was purpose20 (0.35 conf)
typeno__21 was typeno21 (0.35 conf)
signature_date__22 was date21 (1.00 conf)
amt__21 was amt21 (0.35 conf)
rec__21 was rec21 (0.35 conf)
purpose__21 was purpose21 (0.35 conf)

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

Supplement to Petitioner's Verified Accounting

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