Free mc391a.pmd - Michigan

Approved, SCAO

Original - Court 1st copy - Employee 2nd copy - Employer

STATE OF MICHIGAN JUDICIAL DISTRICT JUDICIAL CIRCUIT
Court address

CASE NO. ORDER CANCELING ASSIGNMENT OF WAGES
Court telephone no.

In the matter of
Name of employee Address City Last four digits of social security no. or employee ID no. State Zip

Date of birth Telephone no.

1. On
Date

this court entered an order directing per

Name of employer

to withhold $ THE COURT FINDS:

from the earnings owed the person named above.

2. Assignment of wages is unnecessary because IT IS ORDERED:

voluntary payments are being made.

the debt has been satisfied.

3. The assignment of wages of the person named above is canceled.
Date Judge Bar no.

CERTIFICATE OF MAILING I certify that on this date copies of this order were served on the employee and employer by first-class mail to their last-known addresses as defined by MCR 2.107(C)(3).
Date Signature

MC 391 (3/09)

ORDER CANCELING ASSIGNMENT OF WAGES

MCL 769.1k, MCL 771.3(2)(f)