Free Order to Cancel State Income Tax Intercept - Michigan


File Size: 20.1 kB
Pages: 1
Date: February 12, 2008
File Format: PDF
State: Michigan
Category: Juvenile - Court Forms
Word Count: 225 Words, 1,319 Characters
Page Size: Letter (8 1/2" x 11")
URL

http://courts.michigan.gov/scao/courtforms/juvenile/jc62.pdf

Download Order to Cancel State Income Tax Intercept ( 20.1 kB)


Preview Order to Cancel State Income Tax Intercept
Approved, SCAO

Original - Court 1st copy - Debtor 2nd copy - Department of Treasury

STATE OF MICHIGAN
JUDICIAL CIRCUIT - FAMILY DIVISION

COUNTY
Court address

ORDER TO CANCEL STATE INCOME TAX INTERCEPT

CASE NO. PETITION NO.

Court telephone no.

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

THE COURT FINDS: 2. On
Date

this court entered an order directing the Michigan Department of Treasury to withhold up to of any state income tax refund due to

$

First, middle initial, and last name and social security no. Address City, state, zip

First, middle initial, and last name and social security no. Address City, state, zip

to reimburse the court for costs of care and/or services assessed in the above matter which had become delinquent. in full $ 3. The above person(s) paid in part $ 4. Other: on
Date

on
Date

. .

5. IT IS ORDERED the order to intercept state income tax is cancelled and the Michigan Department of Treasury shall delete the order from its records.

Date

Judge

Bar no.

CERTIFICATE OF MAILING I certify that on this date copies of this order were served upon the person(s) named above by ordinary mail at their last known addresses.

Date

Signature

Do not write below this line - For court use only

JC 62 (6/03)

ORDER TO CANCEL STATE INCOME TAX INTERCEPT

MCL 712A.18(2), MCL 769.1(7)