COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : State of Michigan : 54th Judicial Circuit Family Division FINANCIAL AFFIDAVIT : Tuscola County Plaintiff(s) FRIEND OF THE COURT 449 GREEN ST, CARO MI 48723 Index No. Calendar No. Case Number JUDICIAL SUBPOENA -against- : Phone: (989) 673-4848 Fax: (989) 673-4898 YOU MUST TYPE OR PRINT THIS FORM IN INK. YOUR NAME: __________________________ : ONLY COMPLETE ALL AREAS THAT APPLY. : OTHER PARTY: _________________________ 1. Please list all minor children, adopted or natural, that are living: in your household: Defendant(s) ...................................................... NAME DATE OF BIRTH SOCIAL SECURITY NUMBER RELATIONSHIP THE PEOPLE OF THE STATE OF NEW YORK ________________________________________________________________________________ TO ________________________________________________________________________________ ________________________________________________________________________________ GREETINGS: the Honorable at the 2. Do you pay child support on cases other than this one: WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before , ( Court ) YES ( ) NO located at County of amountat ina. If yes, list below (Do not include any , 20 room , on the day of , paid on past in the support).and at any recessed o'clock due noon, or adjourned date, to testify and give evidence as a witness inCounty of on the part of the this action __________ State of __________ Amount $__________ per __________ in the Amount $__________ per __________ in the County of __________ State of __________ Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a 3. Do you of your failure to comply. ( ) YES ( ) NO result pay spousal support/alimony: b. If yes, to whom:__________________________________________ __________ in the County of __________ State of __________ CourtAmount $__________per day of in County, , 20 YOUR INCOME INFORMATION: Occupation:________________________________ Employed by:_______________________________ Occupational License No._______________ Date Hired: __________ Attorney(s) for (Attorney must sign above and type name below) Witness, Honorable , one of the Justices of the Employer's Address: _______________________________________________________________ Salary per pay period is $____________ Circle One: weekly, bi-weekly, semi-monthly, monthly Hourly Pay $____________ Do you have a second job: ( ) YES ( ) NO Office and P.O. Address If yes, date hired: ____________ Employer's Name and Address: ______________________________________________________ Telephone No.: Facsimile No.: Salary per pay period is $____________ Circle One: weekly, bi-weekly, semi-monthly, monthly CHILD CARE INFORMATION: E-Mail Address: Mobile Tel. No.: American LegalNet, Inc. www.USCourtForms.com COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : Index No. Do you have child care expenses for the minor children involved in this case: ( ) YES ( ) NO : Calendar No. If yes complete the following information: Name of child care provider: _____________________________ : Name(s) of child(ren) receiving child care: 1._____________________ 2. _____________________ JUDICIAL SUBPOENA Plaintiff(s) 3._____________________ 4. _____________________ -against: Current weekly child care cost $____________________ DEDUCTIONS: Pension : : $__________ Per __________ Union Dues $__________ Per __________ Defendant(s)Disability Ins $__________ Per __________ Deferred Income $__________ Per __________ : ...................................................... Other $__________ Per __________ Other $__________ Per __________ Health Care Ins $__________ Per __________ THE PEOPLE OF health insurance: YORK ***Portion for children'sTHE STATE OF NEW$__________ Per __________ Life Insurance $__________ Per __________ ***Are the children beneficiaries: ( TO MONTHLY INCOME FROM ALL SOURCES: ADC ____________ ____________ Strike Pay/ Sub Pay Social Security ____________ ____________ ) YES ( ) NO GREETINGS: General Assistance Unemployment Comp ____________ WE COMMAND YOU, that all businessWorkers' Compensation you and each of you attend before and excuses being laid aside, ____________ , the Honorable at the Commission/Bonus ____________ Alimony Received Court ____________ located at County of Supplemental Security, on the Pension, at ____________ at any recessed in room day of , 20 o'clock in the noon, and orIncome date, to testify and give evidence as aArmed Services adjourned witness in this action on the part of the ____________ ____________ Sick Benefits/Disability ____________ Adoption Subsidies ____________ VA/GI Benefits ____________ Rental Income Your failure to comply with this subpoena is punishable as a contempt of ____________ court and will make you liable to the party on this subpoena was National Guard whose behalf____________ issued for a maximum penalty of $50 and all damages sustained as a Other ____________ result of your failure to comply. COMMENTS: Witness, Honorable , one of the Justices _______________________________________________________________________ of the Court in County, day of , 20 _______________________________________________________________________ _______________________________________________________________________ I hereby declare the above to be true to the best of my knowledge. (Attorney must sign above and type name below) Dated: ___________________ Signature: __________________________________ REMEMBER!! Attorney(s) for ATTACH COPIES OF LAST EIGHT PAYSTUBS AND LAST YEAR'S TAX RETURNS WITH W-2'S ATTACHED. CHILD SUPPORT SERVICES APPLICATION I request support services available under Title IV-D of the Social Security and P.O. Address that I must cooperate in Office Act. I understand taking support action to ensure that my child support case remains open. I declare that the information provided above is true and correct to the best of my knowledge and agree to report changes in my circumstances which may affect support action in my case. Date: _________________ Telephone No.: Facsimile No.: Signature: ____________________________________________________ E-Mail Address: Mobile Tel. No.: American LegalNet, Inc. www.USCou