Plaintiff’s name, address, and telephone no.                      

 obligor

 

v

Defendant’s name, address, and telephone no.                 

 obligor

TO THE OBLIGOR:

YOU ARE NOTIFIED: A lien in the amount of your arrearage is in effect against your property as indicated on the attached 
notice of lien.

The property is subject to seizure unless you respond by paying the arrearage or requesting a review within 21 days of the 
date this notice was mailed.

At a requested review, you may object to the lien and proposed action based on a mistake of fact concerning the overdue
support amount or that you are not the person named in the case.

If you believe that the amount of support ordered should be modified because of a change in circumstances, you may file a
motion with the court to modify the support order.

Date

Signature of friend of the court authorized representative

 

CERTIFICATE OF MAILING

I served a copy of this notice and the Notice of Lien 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

Signature  

 

 

Approved, SCAO
Form FOC 91, Rev. 3/21
MCL 552.625b(4)
Page 1 of 1

Distribute form to: 
Court 
Friend of the court 
Plaintiff 
Defendant

STATE OF MICHIGANJUDICIAL CIRCUITCOUNTYNOTICE OF PERFECTION OF LIENCASE NO. and JUDGE(Claimant’s Case Number)Court addressCourt telephone no.