Free jc52.p65 - Michigan

Approved, SCAO

JIS CODE: MSM

STATE OF MICHIGAN
JUDICIAL CIRCUIT - FAMILY DIVISION

COUNTY
Court address

MOTION AND ORDER FOR MODIFICATION OR CANCELLATION OF MINIMUM STATE COSTS OWED

CASE NO. PETITION NO.

Court telephone no.

1. In the matter of
name(s), alias(es), DOB

MOTION 2. I have been ordered to pay minimum state costs in the amount of $ those costs. and am not in willful default of repayment of

3. Payment of the amount due as previously ordered is imposing a manifest hardship for the following reasons:

4. I request that the court cancel the payment of the unpaid portion. I declare that this motion has been examined by me and that its contents are true to the best of my information, knowledge, and belief.

Signature of juvenile Name (type or print)

Date

Address City, state, and zip Telephone no.

ORDER Date of Hearing: Judge/Referee:
Bar no.

5. The court finds that the prior order for minimum state costs imposes the following hardship(s):

IT IS ORDERED: 6. The method of payment is modified as follows:

7. The obligation to pay the minimum state costs is cancelled as to the amount of $ 8. The motion is denied.

.

Date

Judge

Do not write below this line - For court use only

MCL 712A.18(19) JC 52 (11/05)

MOTION AND ORDER FOR MODIFICATION OR CANCELLATION OF MINIMUM STATE COSTS OWED