Free foc108.pmd - Michigan

Approved, SCAO

Original - Friend of the court Copy - Filing party

STATE OF MICHIGAN JUDICIAL CIRCUIT COUNTY
Friend of the court address

CASE NO. CHANGE IN PERSONAL INFORMATION
Telephone no.

Please type or print information. Complete only those sections that apply. You can only file changes for yourself or those minor children of whom you have physical custody. Use another form when making changes for more than one person. You must sign this form

and send it to the friend of the court. 1. New Address and/or Telephone Number
Street address City

for party and minor child(ren) for party only for minor child _____________________ no longer living with custodial parent
Name

State

Zip

Area code and telephone number

I understand that by filing this change of address, it will be used to automatically update address information on any other child support cases I have in Michigan. This change is effective for (check all that apply) all addresses you have listed for me. mailing address only (where I receive mail). residence address only (where I live). legal address only (where I want legal notices to be sent). an address that is confidential by court order and which remains confidential with this change. 2. Alternate Address The court has entered an order making my address confidential under Michigan Court Rule 3.203(F). The following is an alternate address for the court, the friend of the court office, and the other party to use in serving me with notice and other court papers. I will retrieve all my mail regarding this case from this alternate address.
Street address City State Zip

3. Name Change (Attach order changing name or certificate of marriage.)
New name

4. New Employer
Employer name City

Employer information is confidential by court order.
Street address State Zip Area code and telephone number

5. New Driver's License
Issuing state License number Expiration date

6. New Occupational License
Issuing state Type of occupation License number Expiration date

7. New Social Security Number
Social security number

for you

for minor child
Name

8. Health Care Insurance Provider
Provider name Provider address and telephone number Group number Policy number

9. Other Information: (To be provided as ordered by the court.) (Attach separate sheet.)
Name of party filing the change (type or print) Signature of party filing the change Social security number Date of filing

Name of other party (type or print)

FOC 108 (3/08)

CHANGE IN PERSONAL INFORMATION