Approved, SCAO STATE OF MICHIGAN CASE NO. JUDICIAL CIRCUIT - FAMILY DIVISION PETITION NO. ORDER CANCELLING WAGE ASSIGNMENT COUNTY Court address Court telephone no.1. In the matter of (name(s), alias(es)) THE COURT FINDS: 2. On this court entered an order directing Date Name of employer to withhold $ from the wages of to reimburse Amount and terms Name of person responsible for the care of the minor the court for costs assessed in the above matter. 3. The person responsible for the care of the minor has fulfilled all reimbursement requirements and the court has received full payment. IT IS ORDERED: 4. Assignment of wages of is cancelled. Name of person responsible for the care of the minor Date Judge Do not write below this line - For court use only JC 58 (6/03) ORDER CANCELLING WAGE ASSIGNMENT MCL 712A.18b