Fill and Sign the Mi Annulment Michigan Form

RECORD OF DIVORCE OR ANNULMENT MICHIGAN DEPARTMENT OF PUBLIC HEALTH Court Case Number State File Number County Circuit Court 1. Husband’s Name       2. Husband’s Birthdate       First, Middle, Last Month, Day, Year 3. Husband’s Residence       City, Village or Township County State 4. Husband’s Birthplace       5. Number of this Marriage       State or Foreign Country First, Second, etc. (Specify ) 7. Wife’s Name       8. Wife’s Birthdate       First, Middle, Last Month, Day, Year 9. Wife’s Residence       City, Village or Township County State 10. Wife’s Birthplace       11. Number of this Marriage       State or Foreign Country First, Second, etc. (Specify) 12. Place of this Marriage       City, Village or Township County State or Foreign Country 13. Date of this Marriage       14. Date Couple Last Resided Check if Month, day, Year in Same Household Not       Separated Month, Day, Year 15. Nu mber of Minor Children in Household at Separation Date (Filing Date if Not Separated) Check if       None 16. Plaintiff 17. Plaintiff’s Attorney       Husband Wife Other Name (Type or Print) 18. Attorney’s Address       Number and Street City State Zip Code 20. Number of Minor Children whose 19. Judgement of       Physical Custody was Awarded to: Husband Wife Joint Other ___ Divorce/Annulment (Specify) Number Number Number Number No Children 21. Judgement Recorded on       22. I certify that this Divorce was granted on       Month, Day, Year Month, Day,Year 23. Certifying Official       Signature Title Date Signed Failure to provide the required information is a misdemeanor punishable by imprisonment Of not more than 1 year or a fine of not more than $1,000.00 or both