STATE OF MICHIGAN 6th JUDICIAL CIRCUIT OAKLAND COUNTY ORDER FOR DISCHARGE OR ABATEMENT OF ARREARS FOLLOWING COMPLIANCE WITH PAYMENT PLAN Payer CASE NO. ______________ HON. __________________ Court telephone no.: (248)858-0424 Court address: 230 Elizabeth Lake Road, Pontiac, MI 48341-0424 Plaintiff name and address Defendant name and address Payer V S FINDINGS 1. 2. A hearing was held on _____________________. Date Petitioner/Payer, ____________________________, requested this Court enter an order for payment plan pursuant to MCLA 552.605e. An Order for Payment Plan was entered on ______________. Date 3. 4. Payee, ____________________, was was not present at the hearing. Petitioner/Payer complied with the Order for Payment Plan. Petitioner/Payer substantially complied with the Order for Payment Plan. Petitioner/Payer did not comply with the Order for Payment Plan. ORDER At a session of court on _____________ Petitioner/Payer's arrears are adjusted on this case to the following amounts: (adjustment shall be evenly distributed on the account if there is more than one component in a category) a. $ ______________ arrears to __________________________, the child's custodian. b. $ ______________ arrears to the State of Michigan. c. $ ______________ arrears to Medicaid/confinement reimbursement. d. $ ______________ to FOC fees. e. $ ______________ arrears to other agency debt types: ______________________. Petitioner/Payer `s arrears remain as currently reflected by the records of Friend of the Court on this case with no adjustment. Other: Plaintiff (if consent/stipulation) Date Date Defendant (if consent or stipulation) Judge Date Bar no. American LegalNet, Inc. www.FormsWorkflow.com