PARENTING TIME DENIED AFFIDAVIT *** MUST BE TYPED OR PRINTED, FULLY COMPLETED, SIGNED, AND DATED State of Michigan 54th Judicial Circuit CASE NUMBER: Tuscola County Friend of the Court, Courthouse, 440 N. State Street, Caro MI 48723 Telephone: 989-673-4848 fax: 989-673-4898 PLAINTIFF DEFENDANT Name: Name: Address: Address: City, State, Zip: City, State, Zip: Phone: Phone: [ALLEGED DENIAL MUST BE SUBMITTED TO THE FOC WITHIN 56 DAYS OF THE DATE] (Attach additional sheets if necessary) Now comes and submits this PARENTING TIME AFFIDAVIT as follows: (Your Name) 1. That I am entitled to parenting time with: birthdate: pursuant to Court Order dated: . 2. Beginning at (time) on (date) until (time) on (date) I was denied parenting time by because of: (Explain why the other party denied your parenting time) That I ( ) DID or ( ) DID NOT attempt to pick up the child(ren) at the ( ) home or ( ) other court ordered exchange location. Further I ( ) DID or ( ) DID NOT wait the 15 minutes as required by the Tuscola County Friend of the Court guidelines. 3. That I ( ) HAVE or ( ) HAVE NOT been denied parenting time before. 4. That ( ) I request makeup parenting time as determined by the Friend of the Court; and/or ( ) I request that a joint meeting be scheduled by the Friend of the Court; and/ or ( ) other: . ****MUST SIGN AND PRINT NAME**** Date Signed Signature of complaining party Printed name of complaining party American LegalNet, Inc. www.FormsWorkFlow.com