Date of arrest/appearance

Arresting agency and address

       

    

Agency file no.

RECEIPT

Received on behalf of 
of the payer’s support obligation. The payer shall appear for hearing at a date noticed to the payer by the court at the

 (the payer of support) $ 

 to assure the performance

 

 

following address: 

Address furnished by the payer for receipt of notice

The hearing is for the payer to answer to the contempt proceeding and, if the payer was found in contempt, to further 
proceedings related to the payer’s contempt. If the payer fails to appear at the time and place indicated in the court’s 
notice and submit to the jurisdiction of the court and fails to abide by an order of the court, the cash performance bond 
deposited shall be transmitted to the friend of the court or to the state disbursement unit for payment of the arrearage 
to the recipient of support and of costs to the court. If the payer appears at the time and place indicated above and the 
court determines that the payer owes an arrearage under the support order that is the basis of the contempt proceeding 
or owes costs to the court, the cash performance bond deposited shall be transmitted to the office of the friend of the 
court or to the state disbursement unit for payment of the arrearage to the recipient of support and of costs to the court. 
By depositing the cash performance bond with the officer and accepting this receipt, the recipient of this receipt 
waives a claim to the money under the cash performance bond following its transmittal to the friend of the court 
or to the state disbursement unit.

Date

Officer

                                                     

Signature of depositor of money

        

Department

      

Department receipt number

PlaintiffvDefendantSTATE OF MICHIGANJUDICIAL CIRCUITCOUNTY CASH PERFORMANCE BOND(Civil Contempt)CASE NO. and JUDGECourt addressCourt telephone no.Approved, SCAOForm FOC 4, Rev. 5/21MCL 552.632Page 1 of 2Distribute form to: Court RespondentFriend of the courtArresting agencyDepositorCash Performance Bond (Civil Contempt) 
Page 2 of 2

(5/21) 

Case No. 
 

To secure my release from custody until the court hearing, I promise:

TERMS AND CONDITIONS  

1. I will personally appear at 

    on 

Date

Location

Time

 or as otherwise directed by the court.

2. I will immediately notify the court and the friend of the court in writing of any change in my address or telephone number.

I understand that at the hearing the court will determine how much of the bond money will be paid to the friend of the court 
to be applied to my support account and how much, if any, will be returned.

I understand that if I fail to appear the court may issue a bench warrant for my arrest and the bond money will be applied 
to my support account.

mployer’s address

 E

 
 
 
 
 
 
 
 
 

mployer

 E

 
 
 
 
 
 
 
 
 

   

Date

Signature

Address

City, state, zip

                                                                                                 

City, state, zip