STATE OF MICHIGAN IN THE CIRCUIT COURT FOR THE COUNTY OF TUSCOLA FAMILY DIVISION Plaintiff’s name and address: ___________________________ ___________________________ ___________________________ File No. _____________________ Defendant’s name and address: ___________________________ ___________________________ ___________________________ REQUEST FOR TELEPHONE HEARING I, ___________________________, request to appear by telephone for the Referee hearing scheduled on _______________________________ for the following specific reasons (reasons as to why you want to appear by telephone:) ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ I declare the above statements are true to the best of my knowledge. Dated: ___________________ _________________________________ Signature of Petitioner NOTICE: The court will grant the request unless written objections are filed with the Court within seven (7) days. Return this form to the 54th Judicial Circuit Court Referee, 449 Green St, Caro, MI 48723. (Friend of the Court Building) ****************************************************************************** ( ) Granted ( ) Denied __________________________________ jlp 08/29/06 *PTELHRG* American LegalNet, Inc. www.FormsWorkFlow.com