STATE OF MICHIGAN 6th JUDICIAL CIRCUIT OAKLAND COUNTY MOTION FOR PAYMENT PLAN and MOTION FOR SURCHARGE ABATEMENT Court address: 230 Elizabeth Lake Road, Pontiac, MI 48341-0424 Plaintiff name and address CASE NO. _________________ HON. _____________________ Court telephone no.: (248)858-0424 q Payer q Payer Defendant name and address VS I, ____________________________, am the person ordered to pay support. I request this court enter an order for payment plan pursuant to MCLA 552.605e and an abatement of surcharge pursuant to MCLA 552.603d or the following reason(s): 1. Friend of the Court (FOC) records show that I owe support arrears in this case. 2. FOC records show that, as of _________________: today’s date a. My current support is $_______/month. My youngest child will be/was 18 on ________. Date b. My total arrears are $________________. A FOC print is attached. For items c. through g., these amounts are the totals for the obligations for each debt type. c. I owe $ ______________ support arrears to __________________, the custodial parent. d. I owe $ ______________ support arrears to the State of Michigan. e. I owe $ ______________ to Medicaid/confinement reimbursement arrears. f. I owe $ ______________ to unpaid FOC fees. g. I owe $ ______________ to other agency debt type arrears: _________________. 3. It is in the best interests of the parties and the children that a payment plan be ordered in this case. 4. As to arrears in 2. a., above, owed to the Individual Payee, I understand that he or she must consent to entry of an order for payment plan. I have not threatened or coerced the payee and the payee’s agreement, if given, is not because of fear, coercion or duress. The arrears did not arise from conduct by the payer engaged in exclusively for the purpose of avoiding a support obligation. 5. As to the other arrears in 2. b. - e., above, owed to various agencies, the arrears did not arise from conduct by the payer engaged in exclusively for the purpose of avoiding a support obligation. 6. I do not have the present ability and will not have ability in the foreseeable future to pay the arrears unless the court orders a payment plan. 7. I have income, before any deductions, in the amount of $____________ per _________. I have time period attached pay and/or other income records and tax returns. 1 American LegalNet, Inc. www.FormsWorkflow.com 8. I have expenses and debts, solely or jointly owed, as of this date, as follows: (This includes but is not limited to: food, rent, vehicles, real estate, credit card accounts, etc.) Attach a separate sheet if you need more space. DESCRIPTION $ OWED 1. 2. $ 3. 9. $ $ I have assets, solely or jointly owned, as of this date, as follows: (Assets include but are not limited to: vehicles, real estate, bank accounts, retirement accounts, trust funds, etc.) Attach a separate sheet if you need more space. DESCRIPTION NET VALUE 1. $ 2. $ 3. $ RELIEF REQUESTED I request the Court award the following relief: A. Order a payment plan of $ ________________ per month for ________ months as of the first date of the month of _______________; B. If the Court declines to order the payment plan proposed in paragraph A. above, then order a payment plan for discharge or abatement of support arrears as found by the Court to be a reasonable monthly payment over a reasonable time, in accordance with my ability to pay; C. Order an abatement of surcharge that discharges surcharge assessed after June 30, 2005 and that remains in place for so long as I comply with the payment plan authorized by the court. D. Grant me such other and further relief as is just and appropriate. I declare that the statements above are true to the best of my information, knowledge and belief. I understand that if I knowingly provide false information, I may be charged with a criminal offense pursuant to MCLA 552.605e (10). DATE: BY: Petitioner/Payer 2 American LegalNet, Inc. www.FormsWorkflow.com