COURT Y .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. .. : Index No. Approved, SCAO STATE OF MICHIGAN JUDICIAL CIRCUIT COUNTY : Plaintiff(s) Original - Friend of the Court 1st copy - Financial institution 2nd copy - Plaintiff 3rd copy - Defendant CASE NO. Calendar No. (Claimant's Case Number) NOTICE OF : CONDITIONAL RELEASE OF LIEN Friend of the Court address -against- JUDICIAL SUBPOENA : FAX no. : Financial institution TO: Telephone no. Plaintiff name, address, and telephone no. Obligor : Defendant(s) : ............................................... v FROM: Friend of the Court - Claimant Defendant name, address, and telephone no. (address above) Obligor OPLE OF THE STATE OF NEW YORK Obligor's date of birth Obligor's social security no. NGS: OBLIGOR'S AFFIDAVIT AND AGREEMENT TO RELEASE FUNDS WE COMMANDaccountthat all business and this account and the owner of the funds of this account. YOU, holder of record for excuses being laid aside, you and each in you attend before 1. I am the , orable 2. No other person has a claim to theat the in this account, or, if such a person exists, I have obtained that person's authorization Court funds located of to release the funds. at , authorize theday of institution, named , at to transfer funds to satisfy the and at any recessed on the 20 o'clock in the noon, conditions of this release. 3. I financial above ned date, Ito testify andthat the financial institution may deduct a fee from the of the give evidence as a witness in this action on the part remaining balance of the account to process this request. 4. understand 5. I agree that if a reversal of the transfer is requested, the release of this lien will be void and the released funds will be subject to the original lien. Obligor's signature Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to on whose behalf this subpoena before me on a maximum penalty of $50 and all damages sustained as a Subscribed and sworn to was issued for , Date your failure to comply. My commission expires: Signature: Date Witness, Honorable CONDITIONAL RELEASE OF LIEN County, day of County, Michigan. Notary public , one of the Justices of the , 20 6. A lien arose against obligor's property by operation of law in the amount of past due child support. Notice of Lien is attached. 7. The friend of the court has determined the lien should be terminated in consideration of the obligor's affidavit and agreement to release of funds as executed above. (Attorney must sign above and type name below) 8. You are notified that the lien has been terminated by the friend of the court subject to the following conditions: a. The financial institution transfers $ to the MiSDU. b. In the event of a reversal of the transfer, the lien will continue in effect for all reversed funds and will reinstate on the account when the financial institution is notified that Attorney(s) for release have not been met. the terms of this 9. In accordance with law and subject to the terms of this release, this notice releases the lien upon receipt by the above named financial institution. Signature of Office and P.O. Address authorized representative Date CERTIFICATE OF MAILING Telephone copy I certify that on this date I mailed a copy of this notice and a No.: of the perfected Notice of Lien to the above named financial Facsimile No.: institution, the plaintiff, and the defendant addressed at their last known addresses. Date FOC 92a (4/02) E-Mail Address: Signature Mobile Tel. No.: NOTICE OF CONDITIONAL RELEASE OF LIEN American LegalNet, Inc. www.USCourtForms.com OMB Control #: 0970-0153