Approved, SCAO Original - Friend of the court Copy - Filing party STATE OF MICHIGAN JUDICIAL CIRCUIT COUNTY Friend of the court address CASE NO. CHANGE IN PERSONAL INFORMATION Telephone no. Please type or print information. Complete only those sections that apply. You can only file changes for yourself or those minor children of whom you have physical custody. Use another form when making changes for more than one person. You must sign this form and send it to the friend of the court. 1. New Address and/or Telephone Number Street address City for party and minor child(ren) for party only for minor child _____________________ no longer living with custodial parent Name State Zip Area code and telephone number I understand that by filing this change of address, it will be used to automatically update address information on any other childsupport cases I have in Michigan. This change is effective for (check all that apply) all addresses you have listed for me. residence address only (where I live). an address that is confidential by court order and which remains confidential with this change. the single mailing address to which all notices and papers will be served. 2. Alternate Address The court has entered an order making my address confidential under Michigan Court Rule 3.203(F). The following is an alternate address for the court, the friend of the court office, and the other party to use in serving me with notice and other court papers. I will retrieve all my mail regarding this case from this alternate address. Street address City State Zip 3. Name Change (Attach order changing name or certificate of marriage.) New name 4. New Employer Employer name City Employer information is confidential by court order. Street address State Zip Area code and telephone number 5. New Driver's License Issuing state License number Expiration date 6. New Occupational License Issuing state Type of occupation License number Expiration date 7. New Social Security Number Social security number for you for minor child Name 8. Health Care Insurance Provider Provider name Provider address and telephone number Group number Policy number 9. Other Information: (To be provided as ordered by the court.) (Attach separate sheet.) Signature of party filing the change Date of filing Social security number Name of party filing the change (type or print) E-mail address FOC 108 (3/13) CHANGE IN PERSONAL INFORMATION American LegalNet, Inc. www.FormsWorkFlow.com