Free Order for Assignment of Wages - Michigan

Approved, SCAO

STATE OF MICHIGAN
JUDICIAL CIRCUIT - FAMILY DIVISION

COUNTY
Court address

ORDER FOR ASSIGNMENT OF WAGES

CASE NO. PETITION NO.

Court telephone no.

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

2. Date of hearing: THE COURT FINDS: 3. On
Date

Judge:

Bar no.

this court entered an order directing

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