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 PERFECTION OF LIEN Court address Court telephone no. Plaintiff's name, address, and telephone no. obligor v Defendant's name, address, and telephone no. obligor TO THE OBLIGOR: YOU ARE NOTIFIED: A lien in the amount of your arrearage is in effect against your property as indicated on the attached notice of lien. The property is subject to seizure unless you respond by paying the arrearage or requesting a review within 21 days of the date this notice was mailed. At a requested review, you may object to the lien and proposed action based on a mistake of fact concerning the overdue support amount or that you are not the person named in the case. If you believe that the amount of support ordered should be modified because of a change in circumstances, you may file a motion with the court to modify the support order. Signature of friend of the court authorized representative Date CERTIFICATE OF MAILING I certify that on this date I served a copy of this notice and the Notice of Lien on the parties or their attorneys by first-class mail addressed to their last-known addresses as defined in MCR 3.203. Signature Date FOC 91 (3/11) NOTICE OF PERFECTION OF LIEN MCL 552.625b(4) American LegalNet, Inc. www.FormsWorkFlow.com