In the matter of 

First and last name(s), alias(es)

 

  DOB 
 

1. Date of hearing: 

 

THE COURT FINDS:

 

  Judge: 

 

2. On 

Date

 this court entered an order directing 

Name

 

to reimburse the court for costs assessed in the above matter.

3. The above person has failed to comply with the order of reimbursement and is in contempt of court.

IT IS ORDERED:

4. 

Name

 

 

 

 

 

Name

 , 

Address

 , 

Address

  employer, shall withhold from the earnings due the person the amount of $ 
 
  after service upon the employer of a true copy of this order, and shall forward the withholding to:

 per week, effective one week

5. The employer shall not use the assignment as a basis, in whole or in part, for the discharge of the employee or for any 
  other disciplinary action against the employee.

6. Your compliance with this order is required by law.

7. This order shall remain in full force and effect until further order of the court.

 

                     

Judge signature and date

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. See 15 USC 1672. When required, withholdings shall be determined using the 
calculation sheet from SCAO-Approved form MC 14 (Garnishee Disclosure).

 

 ,

 .

STATE OF MICHIGANJUDICIAL CIRCUIT - FAMILY DIVISIONCOUNTYORDER FOR ASSIGNMENT OF WAGESCASE NO.PETITION NO.JUDGECourt addressCourt telephone no.Approved, SCAOForm JC 39, Rev. 3/23MCL 712A.18bPage 1 of 1Distribute form to:CourtEmployerCopies as needed