Approved, SCAO Original - Friend of the court 1st copy - Plaintiff 2nd copy - Defendant 3rd copy - For return (Request) STATE OF MICHIGAN JUDICIAL CIRCUIT COUNTY Friend of the court address NOTICE FOLLOWING ORDER FOR PAYMENT OF ARREARAGE (LICENSE SUSPENSION) CASE NO. Telephone no. Plaintiff's name, address, and telephone no. payer Defendant's name, address, and telephone no. payer TO THE PAYER: 1. Date of notice: 2. On Date , the court entered an order conditioning the suspension of your license(s) upon your compliance with an order for payment of arrearages in scheduled installments. 3. You failed to fully comply with that order and your driver's, occupational, recreational, and/or sporting license(s) will be suspended as required in the order for payment of arrearages unless you request a hearing within 14 days to show that you have complied with the order. 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). FRIEND OF THE COURT REQUEST FOR HEARING I request a hearing to show that I have complied with the conditional suspension order. Date Signature MCL 552.629, MCL 552.633(2) FOC 83 (3/15) NOTICE FOLLOWING ORDER FOR PAYMENT OF ARREARAGE (LICENSE SUSPENSION) American LegalNet, Inc. www.FormsWorkFlow.com