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Friend of The Court Case Questionnaire

  1. FRIEND OF THE COURT CASE QUESTIONNAIRE
  2. Court Contact Information

    Telephone (989) 224-5136 Fax (989) 224-5113 

    100 East State Street Suite 4100 St. Johns, MI 48879

  3. **Disclaimer**: As this website is a third-party entity, the Friend of the Court is unable to ensure that ANY documents uploaded to this website will be secure. If you do not wish to upload any or all of the requested documentation through this website, then you may provide the Friend of the Court with the requested documentation through one of the following means:
  4. Mail to: Friend of the Court 100 E State St. Suite 4100, St Johns MI 48879

  5. Fax to: 989-224-5113

  6. You may also call the Friend of the Court office at 989-224-5136 if you have any questions about returning your documents.
  7. PLEASE FILL OUT THIS FORM COMPLETELY, IF REQUIRED INFORMATION IS NOT GIVEN IT WILL NOT BE TAKEN INTO CONSIDERATION AS A POSSIBLE DEDUCTION OR ADDITIONAL EXPENSE. THIS FORM CANNOT BE SAVED. YOU CANNOT LEAVE THIS FORM AND RETURN TO IT AT A LATER TIME. PLEASE REVEIW THIS FORM TO MAKE SURE YOU HAVE EVERYTHING NEEDED TO COMPLETE IT ONCE YOU BEGIN.
  8. Is Address New?*
  9. INCOME INFORMATION
  10. I am self employed
    If you are self employed, you MUST provide complete tax returns for the past three years. You may mail them to the Friend of the Court at 100 E State St., St Johns MI 48879; Fax them to 989-224-5113; use MiCASE at https://micase.state.mi.us/portalapp/public/login.html; or use the Friend of the Court drop box located on the 2nd floor of the Courthouse near security (please place in a sealed envelope). You may also call 989-224-5136 if you have any questions.
  11. If possible, upload this as one file. If not, you can provide additional pay stubs below.
  12. Pay frequency
  13. Additional income frequency
  14. Do you receive Social Security Supplemental Income (SSI)
  15. SSI income frequency
  16. Do you receive Social Security Disability (SSD, VA or Railroad Retirement)
  17. Frequency
  18. PLEASE FILL OUT THIS SECTION IF YOU ARE UNEMPLOYED AND NOT WORKING:

  19. Please provide your prior employment history
  20. Do you have any personal history that prohibits you from working (ex. criminal history; physical/mental health ailments, etc)?
  21. Did you graduate high school?
  22. Did you earn a GED?
  23. Did you attend/graduate college?
  24. Do you have any certifications?
  25. Are you seeking employment
  26. If you are seeking employment, are you looking for:

    Please check all that apply

  27. What hours are you available to work?

    Please check all that apply

  28. What days are you available during the week?

    Please check all that apply

  29. Do you have a driver's license?
  30. Do you have a vehicle?
  31. INFORMATION REGARDING THE OTHER PARENT (if known)
  32. LIST PERSONS IN HOUSEHOLD
  33. INSURANCE INFORMATION
  34. Do you or does someone in your household maintain health insurance for your minor child/ren?
  35. Is this insurance Medicaid/other State Insurance?
  36. Do you maintain mandatory health insurance for yourself?
  37. Do both parties take the child to the doctor?
  38. Does your employer fund an account that pays your uninsured medical expenses? (examples HSA/HRA)
  39. Please select frequency of Your Contribution
  40. Please select frequency of Employer Contribution
  41. Please attach a copy of your current insurance card FOR THE CHILDREN, front and back.
    For your medical cards to be placed on file, we need both the front and back. If possible upload this in one file. If not you can create a single image, please use the check box below.
  42. Do you need to attach an additional image?
  43. Do you need to attach an additonal image?
  44. Do you need to attach an additional image?
  45. CHILDCARE EXPENSES
    Your childcare provider will need to complete the form below and sign it to verify the information is accurate. Forms returned without the signature of the provider will NOT be included when calculating support. Child Care for a child continues through August 31 following that child’s 12th birthday.
  46. Mandatory Contributions
    Does your employer MANDATORILY require you to pay any of the following?
    *to count as a deduction you must supply documentation proving the mandatory contribution.
  47. Union Dues
  48. Retirement Plan
  49. If you contribute a fixed amount per pay period, please provide the amount per pay period.
  50. If you contribute a percentage per pay period, please provide the percentage amount.
  51. Please list/describe other mandatory withholding's. Please provide a cost per pay period for each additional withholding.
  52. If you want Friend of the Court services, you must check the box below.
  53. REMINDER LIST

    • Have you signed this questionnaire?
    • Have you attached your four most recent paycheck stubs, verification of other sources of income, or a statement from your employer(s) of wages, deductions, and year-to-date earnings?
    • Have you attached a copy of your last federal and state income tax returns, including all schedules, W-2's, and 1099's? If self-employed, also attach a copy of your three most recent business tax returns and/or corporation returns.
    • If unemployed, you have filled out the unemployment section of this questionnaire
    • Documentation of health insurance/medical coverage for child/ren 
    • Childcare Verification Form if utilizing childcare for child/ren of this case only

    **Disclaimer**: As this website is a third-party entity, the Friend of the Court is unable to ensure that ANY documents uploaded to this website will be secure. If you do not wish to upload any or all of the requested documentation through this website, then you may provide the Friend of the Court with the requested documentation through one of the options available at the top of this form.


  54. Electronic Signature Agreement*
    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.
  55. Leave This Blank:

  56. This field is not part of the form submission.