Free foc114.pmd - Michigan

Approved, SCAO

Original - Court 1st copy - Plaintiff

2nd copy - Defendant 3rd copy - Friend of the court

STATE OF MICHIGAN JUDICIAL CIRCUIT COUNTY
Court address

CASE NO. ORDER REGARDING FOREIGN TRAVEL
Telephone no.

Plaintiff's name, address, and telephone no.

moving party

Attorney: v
Defendant's name, address, and telephone no. moving party

Attorney:

Date of hearing: IT IS ORDERED:

Judge/Referee:
Bar no.

1. The motion to permit foreign travel is denied. 2.
Name of parent Name of country of planned trip

is permitted to take the following child(ren) out of Michigan to for purposes of
Explain nature of planned trip

.
Specify name(s) and date(s) of birth of child(ren).

Authority to apply for a passport for the minor child(ren) named above is granted.

Plaintiff's signature (only if by consent)

Defendant's signature (only if by consent)

Date

Judge

CERTIFICATE OF MAILING I certify that on this date I served a copy of this order on the parties or their attorneys by first-class mail addressed to their last-known addresses as defined in MCR 3.203.
Date FOC 114 (3/09) Signature of moving party

ORDER REGARDING FOREIGN TRAVEL