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Get MI FOC 23 2019-2024

Mi. gov/Administration/ SCAO/Forms/courtforms/domesticrelations/generalfoc/dhs1201d. pdf FOC 23 3/16 MCR 3. Original - Friend of the court 1st copy - Plaintiff/Attorney 2nd copy - Defendant/Attorney Approved SCAO STATE OF MICHIGAN JUDICIAL CIRCUIT COUNTY 1. Parent s last name CASE NO. VERIFIED STATEMENT First name 3. Date of birth 2. Any other names by which parent is or has been known Middle name 4. Social security number 5. Driver s license number and state 6. Mailing address and residence address if different 7. E-mail address 8. Eye color 9. Hair color 15. Home telephone no. 10. Height 11. Weight 12. Race 16. Work telephone no. 13. Gender 14. Scars tattoos etc* 17. Occupation 18. Business/Employer s name and address 19. Gross weekly income 20. Did this parent apply for or receive public assistance If yes please specify kind and case number. Yes No 21. Other parent s last name 41. a* Name and sex of minor child in case M / F b. Birth date c* Age d. Soc* sec* no. e. Residential address c* Age d. Residential address 43. Health care coverage available for each minor child a* Name of minor child b. Name of policy holder c* Name of insurance co. /HMO d. Policy/Certificate/Contract/Group no. 44. Name s and address es of person s other than parties if any who may have custody of child ren during pendency of this case. I declare that the statements above are true to the best of my information knowledge and belief* Date Signature If any of the public assistance information above changes before your judgment is entered you are required to give the friend of the court written notice of the change. If you want child support services complete form DHS 1201-D available at your local friend of the court office or courts. Original - Friend of the court 1st copy - Plaintiff/Attorney 2nd copy - Defendant/Attorney Approved SCAO STATE OF MICHIGAN JUDICIAL CIRCUIT COUNTY 1. Parent s last name CASE NO. VERIFIED STATEMENT First name 3. Date of birth 2. Any other names by which parent is or has been known Middle name 4. Parent s last name CASE NO. VERIFIED STATEMENT First name 3. Date of birth 2. Any other names by which parent is or has been known Middle name 4. Social security number 5. Driver s license number and state 6. Mailing address and residence address if different 7. Social security number 5. Driver s license number and state 6. Mailing address and residence address if different 7. E-mail address 8. Eye color 9. Hair color 15. Home telephone no. 10. Height 11. Weight 12. Race 16. E-mail address 8. Eye color 9. Hair color 15. Home telephone no. 10. Height 11. Weight 12. Race 16. Work telephone no. 13. Gender 14. Scars tattoos etc* 17. Occupation 18. Business/Employer s name and address 19. Work telephone no. 13. Gender 14. Scars tattoos etc* 17. Occupation 18. Business/Employer s name and address 19. Gross weekly income 20. Did this parent apply for or receive public assistance If yes please specify kind and case number. Gross weekly income 20. Did this parent apply for or receive public assistance If yes please specify kind and case number. Yes No 21. Other parent s last name 41. a* Name and sex of minor child in case M / F b. Birth date c* Age d.

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