Original - Court 1st copy - Friend of the court 2nd copy - Plaintiff 3rd copy - Defendant Approved, SCAO STATE OF MICHIGAN JUDICIAL CIRCUIT COUNTY CASE NO. (Claimant's Case Number) NOTICE OF INTENT TO LEVY Court address Court telephone no. Plaintiff's name, address, and telephone no. Obligor Obligor's date of birth v Defendant's name, address, and telephone no. Obligor 1. A lien arose against obligor's property by operation of law in the amount of past-due support. The lien was perfected on Date by notice sent by the friend of the court. 2. The friend of the court has determined that the obligor did not request a review within 21 days after notice that the lien was perfected or did not establish a mistake of fact as to his or her identity or arrearage at the time of the review. 3. The obligor is notified pursuant to MCL 552.625b(7) that the friend of the court intends to levy upon his/her property. The friend of the court will take appropriate action to have the property converted into a payment to be applied to past-due support. FRIEND OF THE COURT FOC 93 (3/11) NOTICE OF INTENT TO LEVY MCL 552.625a, MCL 552.625b American LegalNet, Inc. www.FormsWorkFlow.com