Free Affidavit of Judgment Debtor - Michigan

Affidavit of Judgment Debtor

Use this form if the court entered a judgment against you and you have been ordered to provide this information to the individual who has the judgment against you.

(Form DC 87)

Complete all blanks starting with the upper left-hand corner. You can fill out the form by tabbing to each item or you can move the mouse to each item. Check box items must be selected by using the mouse. Start with the "court number" in the upper left-hand corner of the form.
Approved, SCAO

Original - Court 1st copy - Plaintiff 2nd copy - Defendant

STATE OF MICHIGAN JUDICIAL DISTRICT
Court address Plaintiff's name and address

CASE NO. AFFIDAVIT OF JUDGMENT DEBTOR
Court telephone no. Defendant's name and address

v

I swear that 1. I am a party in this case. 2. A judgment was entered against me in the amount of $ 3. The following is a true statement of my assets and financial obligations.
Address

.

City, state, zip Birth date SSN Driver's license no. Employer telephone no. City, state, zip

IDENTIFICATION
Telephone no. Employer Address Net earnings

Payday

INCOME $
Checking

Weekly
Account no.

Bi-weekly
Savings

Monthly
Account no.

ASSETS $
Name of bank or financial institution Year Make Lienholder Address

$
Branch location License plate no. Registered to: City, state, zip Owed Name of mortgage holder or landlord Approximate value

Automobile
Amount owed

$

$ Home $
Total money owed to you

Own $

Rent
Value

Monthly payment

$

$
Amount

Specify below each amount of money owed to you, the due date, and the name of the individual, business, etc. who owes you money
Due date Due date Name who owes money Name who owes money

$
Amount

$ (List additional assets on reverse side) I swear under penalties of perjury that this information is true, accurate, and complete.
Date Signature Date

Subscribed and sworn to before me on My commission expires:

, Signature:

County

Michigan.

Deputy court clerk/Notary public

Notary public, State of Michigan, County of

DC 87 (5/07)

AFFIDAVIT OF JUDGMENT DEBTOR

MCL 600.8410

Approved, SCAO

Original - Court 1st copy - Plaintiff 2nd copy - Defendant

STATE OF MICHIGAN JUDICIAL DISTRICT

CASE NO. AFFIDAVIT OF JUDGMENT DEBTOR

Plaintiff's name and address

v

Defendant's name and address

Other Assets: (continued)

DC 87 (6/05)

AFFIDAVIT OF JUDGMENT DEBTOR