Approved, SCAO Original - Court 1st copy - Plaintiff 2nd copy - Defendant 3rd copy - Friend of the court STATE OF MICHIGAN JUDICIAL CIRCUIT COUNTY Court address CASE NO. MOTION AND ORDER TO SHOW CAUSE FOR CONTEMPT (MEDICAL) Court telephone no. Plaintiff's name, address, and telephone no. MOTION 1. The office of the friend of the court has reviewed the records and determined the respondent, Name of respondent , Attorney: v Defendant's name, address, and telephone no. has failed to obtain or maintain health-care coverage for the child(ren) as ordered by the court. 2. I request the court issue an order to show cause why the respondent named above should not be found in contempt for failure to comply with the court's order. Attorney: USE NOTE: This form is for use by the friend of the court. Parties should use form MC 230. Date Friend of the court/Authorized representative ORDER IT IS ORDERED: 3. Name of respondent shall appear on at Location Date at Time to show cause why he/she should not be held in contempt for failure to comply with the court's order. If the named party fails to appear, he/she may be found in contempt and a bench warrant may be issued for his/her arrest. If contempt is found, the court may apply any enforcement remedy allowed under law. 4. This matter will be heard before a referee; however, this matter may be taken before the judge for immediate hearing if necessary. Date Bar no. Judge NOTICE REGARDING HEARING: Each party attending the hearing must dress in a manner appropriate for a court hearing and must not carry any weapons into the courthouse or office of the friend of the court. Do not bring any child to court who will not be called to testify. Complete the attached forms that apply, following the instructions provided. If you require special accommodations to use the court because of a disability, or if you require a foreign language interpreter to help you fully participate in court proceedings, please contact the court immediately to make arrangements. When contacting the court, provide your case number(s). CERTIFICATE OF MAILING I certify that on this date I served a copy of this motion and order on the parties or their attorneys by first-class mail addressed to their last-known addresses as defined in MCR 3.203. Date FOC 2a (3/09) Signature MCL 552.511, MCL 552.625(a), MCL 552.626a, MCL 552.631, MCR 3.208(B)(1) American LegalNet, Inc. www.FormsWorkFlow.com MOTION AND ORDER TO SHOW CAUSE FOR CONTEMPT (MEDICAL)