Approved, SCAO STATE OF MICHIGAN CASE NO. JUDICIAL CIRCUIT - FAMILY DIVISION ORDER FOR PETITION NO. COUNTY ASSIGNMENT OF WAGES Court address Court telephone no.1. In the matter of (name(s), alias(es), DOB) 2. Date of hearing: Judge: Bar no.THE COURT FINDS: 3. On this court entered an order directing Date Name to reimburse the court for costs assessed in the above matter. 4. The above person has failed to comply with the order of reimbursement and is in contempt of court. IT IS ORDERED: 5. , Name Address , employer, shall withhold from the earnings due the person the amount of $ per week, effective one week after service upon the employer of a true copy of this order, and shall forward the withholding to: Name , Address .6. The employer shall not use the assignment as a basis, in whole or in part, for the discharge of the employee or for any other disciplinary action against the employee. 7. Your compliance with this order is required by law. 8. This order shall remain in full force and effect until further order of the court. Date Judge Do not write below this line - For court use only JC 39 (6/03) ORDER FOR ASSIGNMENT OF WAGES MCL 712A.18b