Original - Court 1st copy - Payer 2nd copy - Payee 3rd copy - Friend of the court Approved, SCAO STATE OF MICHIGAN JUDICIAL CIRCUIT COUNTY CASE NO. FINDINGS AND REPORT ON ARREARAGE PAYMENT AMOUNT Court address Court telephone no. Plaintiff's name and address 1. a. Based on an administrative action taken on Date b. After an administrative hearing held on before v Date Defendant's name and address Friend of the court/Referee/Other Bar no. the friend of the court office determines: 2. Application of arrearage guidelines is is not unjust or inappropriate. 3. There 4. There has has has not has not been a mistake of fact regarding the payer's identity. been a mistake of fact regarding the amount of current support or arrears as follows: 5. The specific amounts that the payer should be required to pay for current and past-due support, confinement, and fees are: 6.The prior total payment amount deviates from the arrearage guideline and an alternate total payment amount should should not be set because circumstances have have not changed sufficiently as follows: a. The arrearage and confinement payment amounts determined by application of the arrearage guideline and the factual assumptions or findings upon which this amount is based are: b. The alternate payment amount and the factual assumptions upon which the amount is based are: The alternate payment amount is is not contrary to the best interests of child. c. The alternate payment amount deviates from the arrearage guideline and was calculated as follows: d. The reasons for the alternate payment amount are: e. Other evidence that the individual is is not able to make the alternate payment amount is attached. f. The impact of the alternate payment amount is as follows: 7. NOTICE TO PAYER: You have the right to request a judicial hearing on the record appealing the determination of the administrative review hearing. Based upon these findings, entry of the attached income withholding order is recommended. Date FOC 95 (5/10) Referee/Friend of the court signature FINDINGS AND REPORT ON ARREARAGE PAYMENT AMOUNT American LegalNet, Inc. www.FormsWorkFlow.com