Approved, SCAO Original - Court 1st copy - Respondent 2nd copy - Friend of the court 3rd copy - Arresting agency 4th copy - Depositor STATE OF MICHIGAN JUDICIAL CIRCUIT COUNTY Court address CASE NO. CASH PERFORMANCE BOND (Civil Contempt) Court telephone no. Plaintiff v Defendant Date of arrest/appearance Arresting agency and address Agency file no. RECEIPT Received on behalf of (the payer of support) $ to assure the performance of the payer's support obligation. The payer shall appear for hearing at a date noticed to the payer by the court at the following address: Address furnished by the payer for receipt of notice The hearing is for the payer to answer to the contempt proceeding and, if the payer was found in contempt, to further proceedings related to the payer's contempt. If the payer fails to appear at the time and place indicated in the court's notice and submit to the jurisdiction of the court and fails to abide by an order of the court, the cash performance bond deposited shall be transmitted to the friend of the court or to the state disbursement unit for payment of the arrearage to the recipient of support and of costs to the court. If the payer appears at the time and place indicated above and the court determines that the payer owes an arrearage under the support order that is the basis of the contempt proceeding or owes costs to the court, the cash performance bond deposited shall be transmitted to the office of the friend of the court or to the state disbursement unit for payment of the arrearage to the recipient of support and of costs to the court. By depositing the cash performance bond with the officer and accepting this receipt, the recipient of this receipt waives a claim to the money under the cash performance bond following its transmittal to the friend of the court or to the state disbursement unit. Date Officer Department Signature of depositor of money Department receipt number TERMS AND CONDITIONS To secure my release from custody until the court hearing, I promise: 1. I will personally appear at Location on Date at Time or as otherwise directed by the court. 2. I will immediately notify the court and the friend of the court in writing of any change in my address or telephone number. I understand that at the hearing the court will determine how much of the bond money will be paid to the friend of the court to be applied to my support account and how much, if any, will be returned. I understand that if I fail to appear the court may issue a bench warrant for my arrest and the bond money will be applied to my support account. Signature Address City, state, zip Driver's license no. FOC 4 (3/15) Date of birth Date Employer Employer's address City, state, zip MCL 552.632 CASH PERFORMANCE BOND (Civil Contempt) American LegalNet, Inc. www.FormsWorkFlow.com