1. A judgment was entered against me in this case as stated above. I

1. A judgment was entered against me in this case as stated above. I submit the following information:

2. My average income is about $ every week. two weeks. month.

I am employed and the name and address of my employer is

I am not employed. I am receiving unemployment benefits.

I have a vehicle: Year: Make: Model: Amount Owed: $

The total amount in all my bank accounts is $ .

Write down any other assets and how much they are worth. If you need more space, attach a separate sheet.

I pay $ in rent/mortgage every month. I pay $ in utilities (water, electricity, gas) every month.

I pay $ for court-ordered child support. I pay $ for court-ordered .

Write down any other obligations and how much you pay. If you need more space, attach a separate sheet.

3. a. I ask this court for an order allowing installment payments of the judgment in the amount of $

every week two weeks month starting , and that no garnishment for

wages/personal work and labor issue on this judgment as long as payment is made. OR

b. I have an order for installment payments, but my circumstances have changed and I ask this court for an amended order

in the amount of $ every week two weeks month

starting until paid in full or until further order of the court.

4. A writ of garnishment for periodic payments was issued on . I ask that it be suspended.

5. This affidavit is made on my personal knowledge and, if sworn as a witness, I can testify competently to the facts in this motion

and affidavit.

Subscribed and sworn to me on , County, Michigan.

My commission expires: Signature:

Notary public, State of Michigan, County of

CERTIFICATE OF MAILING

I certify that on this date I served a copy of this motion on the parties or their attorneys by first-class mail to their last-known addresses

as defined in MCR 2.107(C)(3).

NOTICE TO PLAINTIFF: If you do not file objections to the motion with the court and serve them on the defendant within 14 days from the mailing of this

motion, the motion will be granted without further hearing. If you file timely objections, the court will decide the motion based on the papers filed or will

notify the parties that a hearing will be required.

STATE OF MICHIGAN

JUDICIAL DISTRICT

JUDICIAL CIRCUIT

CASE NO.

Approved, SCAO

Defendant's name (judgment debtor), address, and telephone no.Plaintiff's name (judgment creditor), address, and telephone no.

Court telephone no.Court address

MC 15 (8/12) MOTION AND AFFIDAVIT FOR INSTALLMENT PAYMENTS/TO AMEND ORDER FOR INSTALLMENT PAYMENTS

Original - Court

1st copy - Plaintiff

2nd copy - Defendant

MOTION AND AFFIDAVIT FOR

INSTALLMENT PAYMENTS/TO AMEND ORDER

FOR INSTALLMENT PAYMENTS

Date of judgment:

Amount of judgment (including costs): $

Approximate balance due on judgment: $

See instructions on reverse side

Plaintiff's attorney, bar no., address, and telephone no.

MCL 600.6201 et seq., MCR 2.119(B)(1)(c), MCR 3.101(N), MCR 3.104

Defendant's signature

Date

Notary public/Deputy court clerk

Date

Defendant's signature/District court clerk

Form Instructions