Fill and Sign the 2016 2019 Form Mi Foc 23 Fill Online Printable Fillable

15. Home telephone no. 16. Work telephone no. 17. Occupation Approved, SCAO CASE NO. STATE OF MICHIGAN JUDICIAL CIRCUIT COUNTY Original - Friend of the court 1st copy - Plaintiff/Attorney 2nd copy - Defendant/Attorney VERIFIED STATEMENT 1. Parent's last name First name Middle name 6. Mailing address and residence address (if different) 3. Date of birth 4. Social security number 5. Driver's license number and state 8. Eye color 9. Hair color 10. Height 11. Weight 12. Race 13. Gender 14. Scars, tattoos, etc. 18. Business/Employer's name and address 19. Gross weekly income 20. Did this parent apply for or receive public assistance? If yes, please specify kind and case number. Yes No DateSignature 21. Other parent's last name First nameMiddle name 22. Any other names by which parent is or has been known 26. Mailing address and residence address (if different) 23. Date of birth 24. Social security number 25. Driver's license number and state 28. Eye color 29. Hair color 30. Height 31. Weight 32. Race 33. Gender 34. Scars, tattoos, etc. 35. Home telephone no. 36. Work telephone no. 37. Occupation 38. Business/Employer's name and address 39. Gross weekly income 40. Did this parent apply for or receive public assistance? If yes, please specify kind and case number. Yes No 43. Health care coverage available for each minor child a. Name of minor child b. Name of policy holder c. Name of insurance co./HMO d. Policy/Certificate/Contract/Group no. I declare that the statements above are true to the best of my information, knowledge, and belief. 44. Name(s) and address(es) of person(s) other than parties, if any, who may have custody of child(ren) during pendency of this case. MCR 3.206(B) FOC 23 (3/16)VERIFIED STATEMENT 7. E-mail address 27. E-mail address 2. Any other names by which parent is or has been known If any of the public assistance information above changes before your judgment is entered, you are required to give the friend of the court written notice of the change. If you want child support services, complete form DHS 1201-D, available at your local friend of the court office or courts.mi.gov/Administration/ SCAO/Forms/courtforms/domesticrelations/generalfoc/dhs1201d.pdf41. a. Name and sex of minor child in case 42. a. Name and sex of other minor child of either party M / F M / Fb. Birth date c. Aged. Soc. sec. no. e. Residential address b. Birth date c. Age d. Residential address