Approved,  SCAO

STATE OF MICHIGAN

JUDICIAL DISTRICT
JUDICIAL CIRCUIT

MOTION AND AFFIDAVIT FOR
INSTALLMENT PAYMENTS/TO AMEND ORDER
FOR INSTALLMENT PAYMENTS

Original - Court
1st copy - Plaintiff
2nd copy - Defendant
CASE NO.

Court  address

Court  telephone  no.

Plaintiff's name (judgment creditor), address, and telephone no.

Defendant's name (judgment debtor), address, and telephone no.

Plaintiff's attorney, bar no., address, and telephone no.

See instructions on reverse side

v

Date of judgment:

Amount of judgment (including costs): $

Approximate balance due on judgment: $

1. A judgment was entered against me in this case as stated above. I submit the following information:
2. My average income is about $

two weeks.

week.

every

month.

I am employed and the name and address of my employer is

I am not employed.
I have a vehicle: Year:

Make:
The total amount in all my bank accounts is $

I am receiving unemployment benefits.
Model:
.

Amount Owed:  $

Write down any other assets and how much they are worth.  If you need more space, attach a separate sheet.

    .

I pay $
I pay $
Write down any other obligations and how much you pay.   If you need more space, attach a separate sheet.

in rent/mortgage every month.  I pay $
for court-ordered child support. I pay $

      in utilities (water, electricity, gas) every month.
      for court-ordered

    .

3.

a. I ask this court for an order allowing installment payments of the judgment in the amount of $

every
wages/personal work and labor issue on this judgment as long as payment is made.  OR

two weeks

   starting

month

week

, and that no garnishment for

b. I have an order for installment payments, but my circumstances have changed and I ask this court for an amended order

in the amount of $
starting

every

two weeks
until paid in full or until further order of the court.

month

week

4. A writ of garnishment for periodic payments was issued on

.  I ask that it be suspended.
5. This affidavit is made on my personal knowledge and, if sworn as a witness, I can testify competently to the facts in this motion

and affidavit.

Subscribed and sworn to me on

Date

My commission expires:

Date

Notary public, State of Michigan, County of

Defendant's signature

,

Signature:

Notary public/Deputy court clerk

  County, Michigan.

I certify that on this date I served a copy of this motion on the parties or their attorneys by first-class mail to their last-known addresses
as defined in MCR 2.107(C)(3).

CERTIFICATE OF MAILING

Date

Defendant's  signature/District  court  clerk

NOTICE TO PLAINTIFF:  If you do not file objections to the motion with the court and serve them on the defendant within 14 days from the mailing of this
motion, the motion will be granted without further hearing.  If you file timely objections, the court will decide the motion based on the papers filed or will
notify the parties that a hearing will be required.

MCL 600.6201 et seq., MCR 2.119(B)(1)(c), MCR 3.101(N), MCR 3.104
MC 15   (8/12)   MOTION AND AFFIDAVIT FOR INSTALLMENT PAYMENTS/TO AMEND ORDER FOR INSTALLMENT PAYMENTS