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 OF PROPOSED LICENSE SUSPENSION AND REQUEST FOR HEARING Fax no. CASE NO. Telephone no. Plaintiff's name, address, and telephone no. payer TO THE PAYER: 1. Date of mailing: 2. The friend of the court office has reviewed your files and determined there is an arrearage of: Defendant's name, address, and telephone no. payer 3. Pursuant to Michigan law, if you have an arrearage of support of two or more months, your driver's, occupational, recreational, and/ or sporting licenses may be subject to a suspension order. 4. A suspension order or notice will be sent to the licensing agency unless you a. pay the arrearages in full within 21 days, or b. request a hearing on the proposed suspension within 21 days after the date this notice is mailed. See Request for Hearing below. 5. If you request a hearing, you may a. object to the proposed suspension based on a mistake of fact about your identity as the payer or the amount of arrearage and you can show that the arrearages are less than two months' worth of the current support amount. b. ask the court to order a schedule for payment of arrearage. c. request the court to delay suspension until after a hearing on a motion filed to modify the current support amount because of a change in circumstances. 6. If you believe the support amount should be modified because of a change in circumstances, you may: (1) file with the court a motion to modify the support order, and (2) request a hearing on the proposed suspension within 21 days after the date this notice is mailed. 7. Once an order of suspension is entered and sent to a licensing agency, you will be responsible for paying all fees and charges imposed by that agency for reinstatement of the license. 8. If you wish to request a hearing on the proposed suspension, complete the Request for Hearing below and return a copy of this form to the above friend of the court address. 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 on the proposed license suspension (Check the reasons that apply.) a. because there is a mistake of fact about my identity as the payer. b. because there is a mistake of fact about the amount of arrearage and I can show that arrearages are less than two months' worth of the current support amount. c. to ask the court to order a schedule for payment of the arrearage. d. to request the court to delay suspension until after a hearing on a motion filed to modify the current support amount because of a change in circumstances. Date FOC 80 (5/10) Signature of payer NOTICE OF PROPOSED LICENSE SUSPENSION AND REQUEST FOR HEARING MCL 552.628, MCL 552.629 American LegalNet, Inc. www.FormsWorkFlow.com