Approved, SCAO
JIS CODE: MSM
STATE OF MICHIGAN
JUDICIAL CIRCUIT - FAMILY DIVISION
COUNTY
Court address
MOTION AND ORDER FOR MODIFICATION OR CANCELLATION OF MINIMUM STATE COSTS OWED
CASE NO. PETITION NO.
Court telephone no.
1. In the matter of
name(s), alias(es), DOB
MOTION 2. I have been ordered to pay minimum state costs in the amount of $ those costs. and am not in willful default of repayment of
3. Payment of the amount due as previously ordered is imposing a manifest hardship for the following reasons:
4. I request that the court cancel the payment of the unpaid portion. I declare that this motion has been examined by me and that its contents are true to the best of my information, knowledge, and belief.
Signature of juvenile Name (type or print)
Date
Address City, state, and zip Telephone no.
ORDER Date of Hearing: Judge/Referee:
Bar no.
5. The court finds that the prior order for minimum state costs imposes the following hardship(s):
IT IS ORDERED: 6. The method of payment is modified as follows:
7. The obligation to pay the minimum state costs is cancelled as to the amount of $ 8. The motion is denied.
.
Date
Judge
Do not write below this line - For court use only
MCL 712A.18(19) JC 52 (11/05)
MOTION AND ORDER FOR MODIFICATION OR CANCELLATION OF MINIMUM STATE COSTS OWED