Here is the text we could read:
In the matter of
Address
Date
OR
IT IS ORDERED:
Employer’s name
3.
STATE OF MICHIGAN
JUDICIAL DISTRICT
JUDICIAL CIRCUIT
WAGE ASSIGNMENT
(PART 1)
CASE NO. and JUDGE
Court address
Court telephone no.
Name of employee
Last four digits of social security no. or employee ID no. Date of birth
City
State
Zip
Telephone no.
1. The defendant is on probation and missed two or more regularly scheduled restitution payments and has signed the
voluntary agreement below:
I agree to the assignment of my wages to pay my financial obligations to the court. I understand that the court may
collect my financial obligations until paid in full.
Signature of defendant
2. This order is issued under MCL 769.1k.
Employer’s address
,
shall withhold from the earnings due to the person named above the amount of $
effective one week after service upon the employer of a copy of this order. The employer shall indicate the case number
on the withholding and shall forward the withholding to the court at
the above address.
per
4. The employer shall not use this assignment as a basis, in whole or in part, for the discharge of the employee or for any
other disciplinary action against the employee.
5. Your compliance with this order is required by law.
6. This order shall remain in full force and effect until further order of the court or until the total of $
has been withheld, whichever comes first.
Most recent balance
Note: Wage assignment is a transfer of the right to receive wages, ordinarily effected by means of a contract. As such, wage
assignments are not within the scope of the federal wage garnishment law. For purposes of this order, however, wages
have been defined based on the federal wage garnishment law. Wages are defined as earnings or compensation paid
for personal services whether called wages, salary, commission, bonus, or otherwise, and can include periodic payments
under a pension or retirement program. (Title III, Section 302, PL 90-321) When required, withholdings shall be determined using
the calculation sheet from SCAO-Approved form MC 14 (Garnishee Disclosure).
Judge signature and date
Approved, SCAO
Form MC 289, Rev. 9/20
MCL 769.1K, MCL 771.3(2)(f), MCL 780.766(18), MCL 780.794(18),
MCL 780.826(15)
Page 1 of 1
Distribute form to:
Court, Part 2
Employee, Part 2
Employer, Part 1
Wage Assignment
Page 2 of 2
(9/20)
Case No.
CERTIFICATE OF MAILING
I served a copy of this wage assignment on the employee and employer by first-class mail addressed to their last-known
addresses as defined by MCR 2.107(C)(3). 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
In the matter of
Address
Date
OR
IT IS ORDERED:
Employer’s name
3.
STATE OF MICHIGAN
JUDICIAL DISTRICT
JUDICIAL CIRCUIT
WAGE ASSIGNMENT
(PART 2)
CASE NO. and JUDGE
Court address
Court telephone no.
Name of employee
Last four digits of social security no. or employee ID no. Date of birth
City
State
Zip
Telephone no.
1. The defendant is on probation and missed two or more regularly scheduled restitution payments and has signed the
voluntary agreement below:
I agree to the assignment of my wages to pay my financial obligations to the court. I understand that the court may
collect my financial obligations until paid in full.
Signature of defendant
2. This order is issued under MCL 769.1k.
Employer’s address
,
shall withhold from the earnings due to the person named above the amount of $
effective one week after service upon the employer of a copy of this order. The employer shall indicate the case number
on the withholding and shall forward the withholding to the court at
the above address.
per
4. The employer shall not use this assignment as a basis, in whole or in part, for the discharge of the employee or for any
other disciplinary action against the employee.
5. Your compliance with this order is required by law.
6. This order shall remain in full force and effect until further order of the court or until the total of $
has been withheld, whichever comes first.
Most recent balance
Note: Wage assignment is a transfer of the right to receive wages, ordinarily effected by means of a contract. As such, wage
assignments are not within the scope of the federal wage garnishment law. For purposes of this order, however, wages
have been defined based on the federal wage garnishment law. Wages are defined as earnings or compensation paid
for personal services whether called wages, salary, commission, bonus, or otherwise, and can include periodic payments
under a pension or retirement program. (Title III, Section 302, PL 90-321) When required, withholdings shall be determined using
the calculation sheet from SCAO-Approved form MC 14 (Garnishee Disclosure).
Judge signature and date
Approved, SCAO
Form MC 289, Rev. 9/20
MCL 769.1K, MCL 771.3(2)(f), MCL 780.766(18), MCL 780.794(18),
MCL 780.826(15)
Page 1 of 2
Distribute form to:
Court, Part 2
Employee, Part 2
Employer, Part 1
Wage Assignment
Page 2 of 2
(9/20)
Case No.
CERTIFICATE OF MAILING
I served a copy of this wage assignment on the employee and employer by first-class mail addressed to their last-known
addresses as defined by MCR 2.107(C)(3). 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
