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Request to Discharge State-Owed Fees

  1. If you think you have good reasons for the Friend of the Court (FOC) to discharge or waive your state-owed debt, please complete all information on this form. You may include more pages if you need more space. You may be asked to fill out more paperwork or provide proof of any of this information. FOC staff may schedule a follow-up meeting with you in person or by phone. Please note that submission of this form is for Clinton County Friend of the Court. If you have a court order in more than one county, please contact the other FOC county office where your additional case(s) are located in regards to seeking discharge of state-owed debt.
  2. **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:
  3. Mail to: Friend of the Court 100 E State St. Suite 4100, St Johns MI 48879
  4. Fax to: 989-224-5113
  5. Return to the Friend of the Court drop box located on the 2nd Floor of the Courthouse. Please put any documents in an envelope if using the drop box.
  6. You may also contact the Friend of the Court at 989-224-5136 if you have any questions about this form
  7. 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. PERSONAL INFORMATION
  9. Please include current last name and any previously used last names if applicable/known
  10. YOUR SITUATION
  11. Above, please list who lives in your household (including any children). Please provide the age and how each person is related to you. Ex. Name-Age-Relation
  12. Does anyone have income/help pay household expenses
  13. In your living situation, do you
  14. Would you be able to pay at least $1,000 at one time if the FOC "matched" the payment amount by discharging an equal amount of your state-owed debt?
  15. Select your highest level of education:
  16. Are you employed:
  17. If unemployed, are you eligible for unemployment benefits?
  18. Are you currently incarcerated (in jail or prison)?
  19. If yes, please complete the following:
  20. Have you been incarcerated in the past?
  21. If yes, please list approximate start and end dates:
  22. If you have been incarcerated previously, is it hard for you to find employment because of your previous jail, prison, or probation sentences?
  23. Are you receiving Social Security payments?
  24. Type of payments:
  25. Are you permanently disabled according to the Social Security Administration (SSA)?
  26. Do you have a disability or orther health issue(s) that may prevent you from working full-time, or from working at all?
  27. Do you currently receive public assistance (FIP, Medicaid, Food Stamps, etc)?
  28. Are you currently under a bankruptcy plan, or are you in the process of filing bankruptcy?
  29. Do you expect to receive money from a will, estate, or trust?
  30. Are you currently living in a homeless shelter or taking part in a homlessness program?
  31. In the past six months, have you been unable to pay medical bills (for either youself or a family member) that you MUST pay?
  32. In the past six months, have you been unable to pay other bills that YOU must pay?
  33. Do you spend time with your child(ren) on a regular basis, attend school activities, and/or consistently exercise your court-ordered parenting time?
  34. In addition to your regular parenting time schedule, do you care for your children while the other parent is at work, at school, etc?
  35. Do you provide non-money support (examples: transportation, clothing, etc.) to your children?
  36. Would you be willing to take a finance or budget class?
  37. Would you be willing to attend a jobs program?
  38. Would you be willing to do volunteer work?
  39. MONTHLY INCOME INFORMATION (LIST GROSS AMOUNTS-BEFORE TAXES)
  40. ASSET INFORMATION
  41. Do you have a savings, checking, or other non-retirement account?
  42. Do you have a retirement savings such as a 401(k)?
  43. Do you own or lease a car of truck?
  44. Do you have any of these items worth over $500?
    Check all that apply
  45. AVERAGE MONTHLY EXPENSES (your share or the amount you pay)
  46. DEBTS
  47. Do you owe restitution as a result of a crime?
  48. Do you owe fees, fines, and/or court costs?
  49. Do you owe someone as a result of a court judgment?
  50. Please note that if any of your state-owed debt is discharged based on incorrect, incomplete, or false information you provided, the FOC may reinstate the debt forgiven (add it back to the total amount owed in support).
  51. Please sign below to indicate that you believe the information you have provided on this form is correct and complete
  52. 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.
  53. The Michigan Department of Health and Human Services (MDHHS) does not discriminate against any individual or group because of race, religion, age, national origin, color, height, weight, marital status, genetic information, sex, sexual orientation, gender identity or expression, political beliefs or disability.
  54. Leave This Blank:

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