ENCAN 10/2018 Seventh Judicial Circuit of Michigan Genesee County Friend of the Court Case No. PLAINTIFF VS. Cancellation of Agreement of Non-Enforcement DEFENDANT I hereby request that the agreement of non-enforcement that I entered into on be cancelled. This agreement will be cancelled effective the first day of the month following the cancellation request. Date Signature Subscribed and sworn to by me this day of , 20. My Commission Expires: NOTARY PUBLIC PLEASE PROVIDE THE FOLLOWING INFORMATION THAT WILL ASSIST THE FRIEND OF THE COURT WITH ENFORCING YOUR CHILD SUPPORT ORDER Current Employer for Payer: Name of Employer Address Address City/State/Zip Code Known Address City/State/Zip Code Address City/State/Zip Code OFFICE USE BY: American LegalNet, Inc. www.FormsWorkFlow.com DHS-1201D (2-16) APPLICATION FOR IV - D CHILD SUPPORT SERVICES FOR OFFICE USE ONLY (For Privately Filed Domestic Relations Cases Only) App Request Date App Returned Date IV-D Case Number State of Michigan Friend of the Court Instructions: This is an applicatio n for IV - D child support services, and is intended only for parents filing a domestic relations case (divorce, annulment, separate maintenance, paternity, or custody) on their own or through their own attorney. This form is not intended for people without children or those who are not a party to a domestic relations case. This application is designed to be used with a Verified Statement, Judgment Information Form, or other similar court form. AUTHORITY: 45 Code of Federal Regulations 302.33. Completion of this application for IV-D child support services is voluntary. Domestic Relations Filing/Docket Number (if available) Who does the child(ren) live with most of the time? (This information is used for administrative purposes only and has no impact on any pending custody hearings.) Mother Father Both What is your relationship to the child(ren) for whom you are applying for child support services? Mother Father A. Mother222s Information Mother222s Name (First, Middle, Last) Mother222s Social Security Number Mother222s Mailing Address (Street, City, State, Zip Code) Mother222s Telephone Number B. Father222s Information Father222s Name (First, Middle, Last, Suffix) Father222s Social Security Number Father222s Mailing Address (Street, City, State, Zip Code) Father222s Telephone Number C. Family Violence Disclosure I believe that disclosure of my address or other identifying information may result in physical or emotional harm to me or th e child(ren). If yes, additional information will be requested by F riend of the Court staff. Yes No D. Acknowledgement for Child Support Recipient If I am sent money in error or overpaid, the Michigan IV - D child support program will take action to correct this error. By checking the 223yes224 box below, I give the IV-D program permission to pay back the error or overpayment by keeping 25% (or otherwise as directed below) from my future child support payments. If I later change my mind, I must contact the Friend of the Court office. Failur e to check 223yes224 has no effect on my eligibility for IV - D child support services. Yes (Check one if different than 25%) 10% 50% No, please contact me before you try to recover an amount from my support payments. E. Ac knowledgement for Applicant I understand that I must provide my Social Security number pursuant to the Social Security Act, 42 USC 66(a)(13), in order fo r Michigan222s child support program to provide services. I have received or have had an opportunity to review a copy of DHS-Pub-748, Understanding Child Support: A Handbook for Parents, at www.michigan.gov/childsupport in the Popular Forms section. I understand that I can also ask for a printed copy from the Friend of the Court. I request child support services available under Title IV-D of the Social Security Act for the child(ren) listed in my domestic relations court filing (refer to DHS-Pub-748 for a list of available services). Applicant or Attorney of Record Signature (Signature is required) Applicant or Attorney of Record Printed Name Date If signed by an a ttorney, (s)he is acting on behalf of Printed Name (Required) The Michigan Department of Health and Human Services (MDHHS) does not discriminate against any individual or group because of race, religion, age, national origin, color, height, weight, marital status, genetic information, sex, sexual orientation, gender identity or expression, political beliefs or disability. Return this completed application to your local Friend of the Court Office. American LegalNet, Inc. www.FormsWorkFlow.com