Form Mc 20 - Affidavit And Order Suspension Of Fees/costs
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1
2Original - Court
2nd copy - Opposing party
Approved, SCAO
1st copy - Applicant
PROBATE OSM CODE: OSF
STATE OF MICHIGAN
CASE NO.
AFFIDAVIT AND ORDER
JUDICIAL DISTRICT
SUSPENSION OF FEES/COSTS
JUDICIAL CIRCUIT
COUNTY PROBATE
Court address
Court telephone no.
Plaintiff/Petitioner name, address, and telephone no.
Defendant/Respondent name, address, and telephone no.
v
Plaintiff's/Petitioner's attorney, bar no., address, telephone no.
Defendant's/Respondent's attorney, bar no., address, telephone no.
Probate
In the matter of
NOTE: Requests for waiver/suspension of transcript
AFFIDAVIT
costs must be made separately by motion.
1. The attached pleading is to be filed with the court by or on behalf of
,
Name
applicant, who is
plaintiff/petitioner.
defendant/respondent.
2. The applicant is entitled to and asks the court for suspension of fees and costs in the action for the following reason:
a. S/he is currently receiving public assistance: $
per
Case No.:
.
b. S/he is unable to pay those fees and costs because of indigency, based on the following facts:
INCOME:
Employer name and address
per
week.
month.
two weeks.
Length of employment
Average gross pay
Average net pay
ASSETS:
State value of car, home, bank deposits, bonds, stocks, etc.
OBLIGATIONS:
Itemize monthly rent, installment payments, mortgage payments, child support, etc.
3. The number of people living in the applicant's household is
.
4. (in domestic relations cases only) The applicant is entitled to an order requiring his/her spouse to pay attorney fees.
REIMBURSEMENT: It is understood that the court may order the applicant to pay the fees and costs when the reason for the waiver
or suspension no longer exists.
Affiant signature
Subscribed and sworn to before me on
,
County, Michigan.
Date
My commission expires:
Signature:
Date
Deputy clerk/Register/Notary public
Notary public, State of Michigan, County of
(SEE REVERSE SIDE FOR ORDER)
AFFIDAVIT AND ORDER, SUSPENSION OF FEES/COSTS
MC 20 (5/07)
MCR 2.002
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