CONSENT ORDERS WITHOUT A REFEREE HEARING * To have a consent order drafted, both parties must appear in person at the Friend of the Court (FOC) office. Please call Jamie Pierce at 989-673-4848 x3214 and set up an appointment. Every effort will be made to accommodate work schedules. * If you can not appear in person, you may call Jamie Pierce at 989-673-4848 x3214 and ask to participate by telephone. (The FOC must pre-approve participation by telephone) ( Order entry fee pursuant to MCL 600.2529(1)(d) is required prior to drafting the order.) Personal Checks and/or Money Orders must be payable to the: Tuscola County Treasurer. $40.00 - Support or medical $80.00 - Custody, parenting time or domicile. * WHAT TO EXPECT ONCE YOU APPEAR IN PERSON AT THE FRIEND OF THE COURT OFFICE: 1. You will meet with the Jamie Pierce who will discuss the terms of the order with you and then draft up an order while you wait. 2. Both parties will review and then sign the order in agreement. 3. This order will then be submitted to the court for entry. 4. A true copy signed by the judge will be sent to each of you. If needed, your account will be adjusted. * WHAT TO EXPECT ONCE YOU APPEAR BY PHONE: 1. You will discuss the terms of the order with Jamie Pierce. 2. Once Jamie has spoken with both of you, an order will be drafted. . (Order entry fee pursuant to MCL 600.2529(1)(d) is required prior to drafting the order.) Personal Checks and/or Money Orders must be payable to the: Tuscola County Treasurer. 3. If one party has appeared, they will review and sign the order in agreement. The FOC will mail this order to the party who did not appear for signature. The order must be mailed back to the FOC for entry with the court. 4. A true copy signed by the judge will be sent to each of you. If needed, your account will be adjusted. jlp 04/03/07 American LegalNet, Inc. www.FormsWorkflow.com INSTRUCTIONS FOR REQUEST OF CONSENT ORDER THIS FORM IS TO ASK THE FRIEND OF THE COURT (FOC) TO PREPARE AN ORDER TO CHANGE A CURRENT ORDER. YOU NEED ONLY FILL IN THE SECTIONS YOU WANT IN THE NEW ORDER. IF THE PARTY HAVING CUSTODY OF THE CHILD(REN) IS ON PUBLIC/STATE ASSISTANCE, (FIP, Food Stamps, Medicaid, Etc.) YOU MAY ONLY CHANGE PARENTING TIME AND/OR DOMICILE GENERAL INFORMATION: This information is necessary to complete the consent order. It must be provided. CUSTODY: To change custody of one or more children, state the name, birth date, and social security number of each child this agreement will affect. State the date this change will occur and which party (mom, dad or third party) will be receiving custody. CHILD SUPPORT: If the parent having custody of the child(ren) is not receiving any form of public assistance, the parties may agree upon the amount of support with the understanding that the chid(ren) is/are entitled to the amount recommended by the Michigan Child Support Formula and that the parent having custody is able to meet the needs of the child(ren) with the agreed upon amount. If you wish to stop child support you must contact the FOC to make sure you can consent to this or if you have to petition. If this section is left blank, the FOC will insert the amount pursuant to the last order of support. If you are deviating from the formula, you must state the reason why. ARREARS: The only past due support that can be waived are those due and owing directly to a Custodial Parent and/or a Third Party. Any and all arrears due and owing the State of Michigan and Tuscola County SHALL BE preserved. CHILD CARE: If the parent who has custody of the child(ren) is not receiving any form of public assistance and is currently paying for child care, the parties may agree to an amount of child care for the non custodial parent to pay. The parties may also ask the FOC to conduct an investigation and recommendation pursuant to the Michigan Formula to determine a child care amount. MEDICAL INSURANCE: Who will be responsible for providing the insurance of the minor child(ren)? If neither party is listed, the order will state both parties are responsible. Medical Insurance Premium: If the party carrying insurance on the minor child(ren) has a medical premium cost, the parties may agree to have the other party pay part or all of the medical premium amount. Please provide the exact amount to be paid. PARENTING TIME: Parenting time shall occur pursuant to the Tuscola County Friend of the Court Guidelines or as mutually agreeable between the parties, unless some other specific schedule is outlined. ENTRY FEE: Personal Checks and/or Money Orders must be payable to the: Tuscola County Treasurer. Entry fee costs are $40.00 for Support or Medical and $80.00 for Custody, Parenting Time, or Change of Domicile. American LegalNet, Inc. www.FormsWorkflow.com TUSCOLA COUNTY FRIEND OF THE COURT Address: 449 Green Street, Caro MI, 48723 Phone: 989-673-4848 Fax: 989-673-4898 Email: foc@tuscolacounty.org Website: www.tuscolacounty.org REQUEST FOR CONSENT ORDER TO CHANGE CUSTODY, PARENTING TIME, MEDICAL INSURANCE AND/OR CHILD SUPPORT NOTE: The Friend of the Court reserves the right to reject this agreement, if necessary. If an attorney represents either party, the attorney must review this form and sign it before an order will be drafted. Both parties must review this form before submitting. Court Order Number:_____________________ Plaintiff’s Full Name, DOB, Address, Telephone No. Defendant’s Full Name, DOB, Address, Telephone No. Minor child(ren): Full Name:_____________________ Full Name:_____________________ Full Name:_____________________ DOB:_____________ DOB:_____________ DOB:_____________ THIS BOX MUST BE COMPLETED OR THE ORDER WILL NOT BE DRAFTED Are you receiving any of the following forms of public assistance: (check all boxes that apply). ( ) grant monies/ADC ( ) child care assistance ( ) medical assistance ( ) not receiving any CUSTODY: Date of Change:___________JOINT LEGAL CUSTODY (Both parties share major decisions) ___YES ___NO Physical Custody change from ___DAD ___MOM to ___DAD ___MOM CHILD SUPPORT AND CHILD CARE: AGAIN, IF THE CUSTODIAL/DOMICILE PARENT IS RECEIVING ANY FORM OF PUBLIC ASSISTANCE, THEN THE PARTIES CANNOT STIPULATE TO CHILD SUPPORT OR CHILD CARE. Do you want the Friend of the Court to determine the Child Support and/or Child Care amount? ____YES____NO If you are agreeing on an amount other than what the Michigan Child Support Formula states, you must state the reason why: ___________________________________________________________________________________________ The new child support amount: $___________ per month per child for __________child(ren) for a total of $________ The new child care amount: $___________per month per child for ___________child(ren) for a total of $________ When will this new amount begin?____________________ Is the Custodial Parent waiving the arrears owing directly to him/her? Child Support _____YES _____NO Child Care _____YES _____NO Ordinary Medical _____YES _____NO American LegalNet, Inc. www.FormsWorkflow.com I understand that the child(ren) is/are entitled to the amount as recommended by the Michigan Child Support Formula, but agree the custodial/domicile parent is able to support the child(ren) on the agreed amount: PLAINTIFF’S EMPLOYER:_________________________________________________________ (name, address and telephone) DEFENDANT’S EMPLOYER:_______________________________________________________ (name, address and telephone) MEDICAL INSURANCE: Who is responsible for health care insurance? _____DAD _____MOM _____BOTH Insurance name and participant: ________________________________________________________________. (Attach copy of card if not submitted to FOC in last 2 years.) What percentage of uninsured health care expenses will be paid by DAD_____% (if this is left blank, the FOC will insert the amount of 50% for each party) MOM_____% Ordinary Medical Expense amount $ __________ (Form with explanation available at FOC office.) What is the new Medical Premium amount you wish the other party to pay for coverage on the minor child(ren): $__________per week or $_________per month for ____________child(ren) PARENTING TIME (BE SPECIFIC): ________________________________________________________________________________________________ ________________________________________________________________________________________________ If no parenting time is specified, the FOC will use: “Parenting time shall occur pursuant to the Friend of the Court Guidelines or as mutually agreeable between the parties.” ORDER ENTRY FEE Pursuant to MCL 600.2529(1)(d) (Order entry fee pursuant to MCL 600.2529(1)(d) is required prior to drafting the order.) Personal Checks and/or Money Orders must be payable to the: Tuscola County Treasurer. COMMENTS: _________________________________________________________________________________________________ I HEREBY DECLARE THE ABOVE TO BE TRUE TO THE BEST OF MY KNOWLEDGE, INFORMATION AND BELIEF. DATE:____________ PLAINTIFF’S SIGNATURE:_______________________________ DATE:____________ DEFENDANT’S SIGNATURE:_____________________________ ATTORNEY(S) SIGNATURE(S): I HAVE READ THE ABOVE AGREEMENT SUBMITTED BY THE PLAINTIFF AND DEFENDANT: DATE:____________ PLAINTIFF’S ATTORNEY:___________________________ DATE:____________ Jlp 04/03/07 DEFENDANT’S ATTORNEY:_________________________ American LegalNet, Inc. www.FormsWorkflow.com