Free foc63.pmd - Michigan

Approved, SCAO

Original - Court 2nd copy - Friend of the court 3rd copy - Plaintiff 4th copy - Defendant

STATE OF MICHIGAN JUDICIAL CIRCUIT COUNTY
Court address

CASE NO. AGREEMENT SUSPENDING IMMEDIATE INCOME WITHHOLDING
Court telephone no.

Plaintiff's name, address, and telephone no.

v
Defendant's name, address, and telephone no.

NOTE: MCL 552.604(3) requires that all new and modified support orders after December 31, 1990. include a provision for immediate income withholding and that income withholding take effect immediately unless the parties enter into a written agreement that the income withholding order shall not take effect immediately.

We understand that by law an order of income withholding in a support order shall take effect immediately. However, we agree to the following. 1. The order of income withholding shall not take effect immediately. 2. An alternative payment arrangement shall be made as follows:

3. Both the payer and the recipient of support will notify the friend of the court, in writing, within 21 days of any change in a. the names, addresses, and telephone numbers of their current sources of income; b. any health-care coverage that is available to them as a benefit of employment or that is maintained by them; the names of the insurance companies, health-care organizations, or health-maintenance organizations; the policy, certificate, or contract numbers; and the names and birth dates of the persons for whose benefit they maintain health-care coverage under the policies, certificates, or contracts; and c. their current residences, mailing addresses, and telephone numbers. 4. We further understand that proceedings to implement income withholding shall commence if the payer of support falls one month behind in his/her support payments. 5. We recognize that the court may order withholding of income to take effect immediately for cause or at the request of the payer.

Date Plaintiff's signature FOC 63 (3/08)

Date Defendant's signature MCL 552.604

AGREEMENT SUSPENDING IMMEDIATE INCOME WITHHOLDING