Statement Regarding Alleged Violation of Custody/Parenting Time Order

2. CLINTON COUNTY FRIEND OF THE COURT
4. 100 E STATE ST., SUITE 4100, ST. JOHNS MI 48879
6. PHONE
   (989) 224-5136

   (989) 224-5136
7. FAX
   (989) 224-5113

   (989) 224-5113
9. STATEMENT REGARDING ALLEGED VIOLATION OF CUSTODY/PARENTING TIME ORDER
11. Plaintiff*
12. Defendant*
14. Case Number
15. Judge
19. There is a custody/parenting time Order in this case, dated:
20. Date:
    Date:
22. 1. The specific provision of the Order that has been violated states as follows:
24. 2. Date(s) of violation(s)
26. 3. Name of violating party
28. Violated the Order by (attach additional pages if necessary)
30. Attach additional page(s)
    If possible, please upload this in one file. If not, please use the check box below.
32. Do you need to attach additional pages?

    1. Yes
34. Attach additional pages
36. Attach additional pages
38. Attach additional pages
40. 3. I request the Clinton County Friend of the Court to enforce the Order of the Court pursuant to their standard procedures
42. I declare that the above statements are true to the best of my knowledge, information and belief
44. Dated*
    Dated
46. First Name*
47. Last Name*
49. Phone Number*
51. 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.

    1. I agree.
53. Electronic Signature*
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55. 1. Receive an email copy of this form.
56. Email address

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57. Submit

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