Here is the text we could read:
STATE OF MICHIGAN
JUDICIAL DISTRICT
JUDICIAL CIRCUIT
ORDER CANCELING
ASSIGNMENT OF WAGES
(PART 1)
CASE NO. and JUDGE
Name of employee
Last four digits of social security no. or employee ID no. Date of birth
Address City State Zip Telephone no.
this court entered an order directing
Name of employer
per
from the earnings owed the person named above.
Court telephone no.
Court address
In the matter of
1. On
Date
to withhold $
THE COURT FINDS:
IT IS ORDERED:
2. Assignment of wages is unnecessary because
voluntary payments are being made.
the debt has been satisfied.
other:
3. The assignment of wages of the person named above is canceled.
Judge signature and date
CERTIFICATE OF MAILING
I served a copy of this order 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
Approved, SCAO
Form MC 391, Rev. 6/22
MCL 769.1k, MCL 771.3(2)(f)
Page 1 of 1
Distribute form to:
Court, Part 2
Employee, Part 2
Employer, Part 1
STATE OF MICHIGAN
JUDICIAL DISTRICT
JUDICIAL CIRCUIT
ORDER CANCELING
ASSIGNMENT OF WAGES
(PART 2)
CASE NO. and JUDGE
Name of employee
Last four digits of social security no. or employee ID no. Date of birth
Address City State Zip Telephone no.
this court entered an order directing
Name of employer
per
from the earnings owed the person named above.
Court telephone no.
Court address
In the matter of
1. On
Date
to withhold $
THE COURT FINDS:
IT IS ORDERED:
2. Assignment of wages is unnecessary because
voluntary payments are being made.
the debt has been satisfied.
other:
3. The assignment of wages of the person named above is canceled.
Judge signature and date
CERTIFICATE OF MAILING
I served a copy of this order 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
Approved, SCAO
Form MC 391, Rev. 6/22
MCL 769.1k, MCL 771.3(2)(f)
Page 2 of 2
Distribute form to:
Court, Part 2
Employee, Part 2
Employer, Part 1
MC 391, Order Canceling Assignment of Wages
This info page is part of the LIT Lab's Form Explorer project. It is not associated with the Michigan state courts.
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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.
last_four_digits_social was Last four digits of social security no or employee ID no (0.54 conf)users1_birthdate was Date of birth (1.00 conf)
We've done our best to group similar variables togther to avoid overwhelming the user.
Suggested Screen 0:
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