STATE OF MICHIGAN WAIVER AND DIRECT PAY CASE NUMBER 54TH JUDICIAL CIRCUIT OF SUPPORT PAYMENTS __________________________ FAMILY DIVISION Friend of the Court, 440 N. State Street, Caro MI 48723 telephone: 989-673-4848 fax: 989-673-4898 Plaintiff's Name, Address and Telephone Number Defendant's Name, Address and Telephone Number Please Print Now comes ______________________________, the payee in the above matter and states as (Your name) follows: Choose only ONE box: [ [ ] I agree to waive $____________ of the past due support that is owed to me. ] I have received the sum of $_________________ for support directly from the payer, __________________________________. (Name of payer) NOTE: CREDIT CANNOT BE GIVEN FOR ANY PERIOD OF TIME PRIOR TO THE EFFECTIVE DATE OF THE SUPPORT. I understand that once the waived amount or direct pay amount is applied to the account, it will no longer be collected by or through the Friend of the Court office. I request the Friend of the Court records to reflect the above stated credit. Dated: _____________________ __________________________________________ Payee Signature __________________________________________ Payee Printed Name *FCREDIT* American LegalNet, Inc. www.FormsWorkFlow.com