Free jc37.pmd - Michigan

Approved, SCAO

JIS CODE: RFF

STATE OF MICHIGAN
JUDICIAL CIRCUIT - FAMILY DIVISION

COUNTY

REQUEST FOR FINANCIAL INFORMATION

CASE NO. PETITION NO.

TO WHOM IT MAY CONCERN:

I authorize my employers, creditors, and others who may have knowledge of my financial affairs to release information to the above court. A photocopy of this authorization shall suffice as an original.

Date

Signature Signature

Please send information on the items checked below regarding:

Name

DOB

Soc. sec. no. or employee/badge no.

EMPLOYMENT INFORMATION (or subsidy)
EARNINGS Hourly Wage ................................................................ Average regular hours worked per week Weekly straight-time pay Average overtime pay per week Salary ................................................ OTHER COMPENSATION $ $ $ $

Hire date DEDUCTIONS (other than taxes) Union dues ( check if required) Insurance ( check if required)

Number of dependents claimed

$ X $ $ per per per per

$ $ $ $ $ $

per per per per per per

0

Credit union

$ per OTHER (Pension, deferred compensation, stock plan, etc.)

FINANCIAL INFORMATION
ASSETS (checking, savings, stocks, bonds, IRAs, etc.)

To be completed by banks, savings and loans, credit unions, loan companies, brokerage firms, etc. LOANS Balance/Value Payment Balance $ Real Estate: $ $ per $ Original loan Motor $ Vehicle: $ per $
Make and year

$ $ $

$ $ $

per per per

$ $ $

Date

Signature

Title

PLEASE RETURN THE ABOVE INFORMATION BY TO THE ADDRESS AT LEFT.
Date

THANK YOU.
JC 37 (9/07)

REQUEST FOR FINANCIAL INFORMATION