Motion And Order For Disclosure Of Income And Health Insurance Information {FOC 21}

Original - Court 1st copy - Friend of the Court 2nd copy - Employer Approved, SCAO STATE OF MICHIGAN CASE NO. MOTION AND ORDER JUDICIAL CIRCUIT FOR DISCLOSURE OF INCOME AND COUNTY HEALTH INSURANCE INFORMATION Friend of the Court address Telephone no.Plaintiff Defendant v Source of income PERSONNEL DEPARTMENT: CONFIDENTIAL TO: MOTION 1. Pursuant to statute, the friend of the court is conducting an investigation. Disclosure of income and available health insurance coverage is essential to the completion of the investigation. 2. is employed by or receives income from the source of income named above. 3. THE FRIEND OF THE COURT REQUESTS that the court order the source of income to disclose all wages, earnings, salaries, commissions, or other income, and all medical, dental, hospitalization, optical, or other health related insurance coverage available to the income recipient. I declare that the statements above are true to the best of my information, knowledge, and belief. Date Friend of the Court ORDER 1. Date of Hearing: Judge: Bar no.2. IT IS ORDERED that the motion for disclosure of income and health insurance information is granted, and the above named source of income shall make immediate and full disclosure as required by the friend of the court. Judge CERTIFICATE OF MAILING I certify that on this date I mailed a copy of this motion and order to the source of income by ordinary mail, addressed to the last known address. Date Signature MCL 552.505, MCL 552.517FOC 21 (6/03) MOTION AND ORDER FOR DISCLOSURE OF INCOME AND HEALTH INSURANCE INFORMATION