Plaintiff’s name and address                                    

 moving party

Attorney:
             v
Defendant’s name and address                                

 moving party

Attorney:

I request:
1. An order permitting me to take the following child(ren) out of Michigan to 

 

for purposes of 

Explain nature of planned trip

  Specify name(s) and ages(s) of child(ren). 

Name of country of planned trip

 .

 Authority to apply for a passport for the minor child(ren) named above.

 
2. Other:

Date

Moving party’s signature

NOTICE OF HEARING

A hearing will be held on this motion on 

Date and time

 at the court address above.

If you require accommodations to use the court because of a disability, or if you require a foreign language interpreter
to  help  you  fully  participate  in  court  proceedings,  please  contact  the  court  immediately  to  make  arrangements.  When 
contacting the court, provide your case number(s).

CERTIFICATE OF MAILING

I served a copy of this motion and notice of hearing on the parties or their attorneys by first-class mail addressed to their 
last-known addresses as defined by MCR 3.203. 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

Approved, SCAO
Form FOC 113, Rev. 3/22
Page 1 of 1

Signature of moving party 

 

 

Distribute form to: 
Court 
Plaintiff 
Defendant 
Friend of the court

 

 

STATE OF MICHIGANJUDICIAL CIRCUITCOUNTYMOTION TO PERMITFOREIGN TRAVELCASE NO. and JUDGECourt addressCourt telephone no.