STATE OF MICHIGAN 6TH JUDICIAL CIRCUIT FAMILY DIVISION ORDER OF REFERENCE TO FOC FAMILY COUNSELING UNIT FOR CUSTODY/PARENTING RECOMMENDATION Court address: 1200 North Telegraph Road, Pontiac, MI 48341 Plaintiff’s name CASE NO. Defendant’s name(s) v. Plaintiff’s attorney, bar no., address & telephone no. Date of Session: _______________ Defendant’s attorney, bar no., address & telephone no. Family Division Judge: ___________________________ P-___________ IT IS ORDERED THAT: 1. This case is referred to the Friend of the Court for a recommendation regarding: [ ] Child Custody [ ] Parenting Time [ ] Change of Domicile 2. [ ] The recommendation shall be issued within 45 days of this Order. [ ] The recommendation shall be issued within __ days of this Order. 3. The following information must be completed in its entirety: (Please type or print) Plaintiff’s Name: __________________________________ Defendant’s Name: _________________________________________ Address: _________________________________________ Address: _________________________________________________ Number Street Apt. Number Street Apt. _________________________________________ City State Zip Telephone: Home __________________________________ Work/Cell __________________________________ __________________________________________________ City State Zip Telephone: Home ___________________________________ Work/Cell _________________________________ 4. Does either party have a Personal Protection Order against the other party? [ ] yes [ ] no 5. A PARTY MUST SCHEDULE A HEARING BEFORE THE COURT WITHIN 21 DAYS OF SUBMISSION OF THE FRIEND OF THE COURT’S RECOMMENDATION, OR THE ORIGINAL MOTION/PETITION WILL BE DISMISSED. NAMES OF MINOR CHILDREN _________________________________________________ DATE OF BIRTH __________________________________________________ _________________________________________________ __________________________________________________ _________________________________________________ __________________________________________________ ________________ Date ___________________________________________ Family Division Judge _________________________________________________ Plaintiff/Plaintiff’s Counsel __________________________________________________ Defendant/Defendant’s Counsel If this case has been referred to the FOC for a recommendation regarding custody or parenting time, you must submit a completed questionnaire to the FOC Family Counselor.. The questionnaire is available at the FOC office or on the following web site: http://www.co.oakland.mi.us/foc/form_application/attorney.html American LegalNet, Inc. www.FormsWorkflow.com