Foc 39 Form PDF Details

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These are some particulars about foc 39 form. Before you fill out the form, it is worth reading through more details on it.

QuestionAnswer
Form NameFoc 39 Form
Form Length4 pages
Fillable?Yes
Fillable fields263
Avg. time to fill out26 min 50 sec
Other namesfoc 39e form, per foc, foc39, per your foc

Form Preview Example

Approved, SCAO

STATE OF MICHIGAN JUDICIAL CIRCUIT

COUNTY

FRIEND OF THE COURT CASE QUESTIONNAIRE

(Page 1)

CASE NO.

Friend of the court address

Telephone no.

Plaintiff

v

Defendant

Complete this form and sign on page 4.

YOUR GENERAL INFORMATION

1. Your full name

 

 

 

 

 

2. Date of birth

 

3.

Place of birth: city and state

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

4. Address

 

 

 

City

 

 

State

Zip

 

5.

Home telephone

6. Work telephone

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

7. Social security number

8. Driver’s license no.

 

 

9. Professional license, type and no.

 

 

 

10. Cell phone

 

11. E-mail address

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

12. Sex

 

13. Eye color

 

14. Hair color

 

15. Height

16. Weight

17. Race

 

18. Scars, tattoos, etc.

M

F

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

19. Your father’s full name

 

 

 

 

 

 

20. Your mother’s full maiden name

 

 

 

 

 

 

 

 

 

21. Children in common with other parent in this case

Birthdate Gender

SSN Anticipated graduation date

No. of overnights you have w/child annually

22.Names of other biological/adopted minor children you support Birthdate Address

23.Are you pregnant? a. When is the child due? b. Is the other party in this case the biological parent of the expected child? 24. Are you presently married?

Yes

No

 

Yes

No

Yes

No

YOUR INCOME, MEDICAL, EDUCATIONAL, AND HEALTH INSURANCE INFORMATION

25. Your occupation

26. Your employer (if unemployed, name of last employer)

27. Employer’s address

City

State

Zip

28. Date hired

29.

Gross earnings per pay period (earnings before taxes)

 

 

 

30. Filing status

 

dependents claimed

 

$

weekly

biweekly

bimonthly

monthly

married

 

single

head of household

 

 

 

 

 

 

 

31.

Hourly pay rate (including shift premium and

32. Total regular hours worked per pay period

 

33. Average overtime hours for past 12

 

COLA)

 

 

 

 

 

 

 

 

months

 

 

 

 

 

 

 

 

 

 

 

 

 

34.

Second job

 

 

 

 

35. Employer

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

36. Employer’s address

City

State

Zip

37. Date hired

38. Gross earnings per pay period (earnings before taxes)

 

 

$

weekly

biweekly

bimonthly

monthly

39. Hourly pay rate

40.Average hours worked per pay period since hire date

41. If unemployed and not receiving unemployment or worker’s compensation benefits, or working part-time only, provide the following information:

Name of last full-time employer

Address of last full-time employer

Postition held at last place of full-time employment

Last day employed full-time

Length of time employed in last full-time position

Reason for leaving last full-time employment

Gross earings per pay period (earnings before taxes)

 

 

$

weekly

biweekly

bimonthly

monthly

FOC 39 (6/17) FRIEND OF THE COURT - CASE QUESTIONNAIRE (Page 1)

Approved, SCAO

STATE OF MICHIGAN JUDICIAL CIRCUIT

COUNTY

FRIEND OF THE COURT CASE QUESTIONNAIRE (Page 2)

CASE NO.

YOUR INCOME, MEDICAL, EDUCATIONAL, AND HEALTH INSURANCE INFORMATION (continued)

42. List MONTHLY income from all other sources, such as:

 

 

Commissions

 

Unemp. Benefits

 

Nat’l Guard & Res. Drill Pay

Bonuses

 

Strike Pay

 

Armed Services

Profit Sharing

 

SUB Pay

 

Allowance for Rent

Interest

 

Sick Benefits

 

Rental Income

Dividends

 

Workers’ Comp.

 

Spousal Support/Alimony

Annuities

 

Soc. Sec. Benefits

 

State Disability Assistance

Pensions/Longevity

 

VA Benefits

 

F I P

Deferred Comp./IRA

 

Disability Insurance

 

Supp. Security Income SSI

Trust Funds

 

GI Benefits

 

Other

43. Do you have any spousal support/alimony orders involving another person not a parent in this case?

 

If so, complete a. b. and c.

No

Yes, as payer

Yes, as recipient

 

 

 

 

a. Amount of order (do not include arrearages)

b. Type of order/Case no.

 

c. City, county, and state

 

 

 

 

 

44. Do any of the children listed on item 21 and 22 receive payments from the Social Security Administration?

Yes

No

Child’s

Name

Amount

(monthly)

Type of benefit (check one)

SSI

Dependent benefit

 

 

Source of dependent benefit (mother, father, stepparent)

45.Attach your four most recent paycheck stubs, or a statement from your employer(s) of wages and deductions, and year-to-date earnings, and a copy of your last federal and state income tax returns, including all schedules. If self-employed, also attach a copy of your three most recent business tax returns and/or corporation returns.

46.Do you have any medical conditions/restrictions that affect your ability to work?

 

If yes, please explain medical condition/restriction:

 

Yes

No

 

 

 

 

 

47.

What is your educational background? (Check one)

 

 

 

 

less than high school

High school graduate

Trade school graduate

 

Associate’s degree

Bachelor’s degree

Graduate degree

48.

Medical insurance company name, address, telephone no.

Policy/Group number

Beginning date, if known

 

 

 

 

 

49.

Dental insurance company name, address, telephone no.

 

Policy/Group number

Beginning date, if known

 

 

 

 

50.

Optical insurance company name, address, telephone no.

Policy/Group number

Beginning date, if known

51. What dependent coverage is available to you without cost?

Medical

Dental

Optical

52. What dependent coverage is available by payment of an additional premium? (Specify cost per pay period.)

 

 

 

Medical

 

per

Dental

per

Optical

 

per

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

53. Individuals currently covered by your insurance

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Name

 

 

 

Birthdate

Relationship

Medical ( )

Dental ( ) Optical ( )

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

FOC 39 (6/17) FRIEND OF THE COURT - CASE QUESTIONNAIRE (Page 2)

Approved, SCAO

STATE OF MICHIGAN

 

 

FRIEND OF THE COURT

 

CASE NO.

 

JUDICIAL CIRCUIT

 

 

 

 

 

 

 

CASE QUESTIONNAIRE

 

 

 

COUNTY

 

 

 

 

 

 

 

(Page 3)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

YOUR CHILD-CARE INFORMATION

 

 

 

 

 

 

 

 

 

 

 

 

54. Do you have child-care expenses for the minor children in this domestic relations case during any time of the year?

Yes

No

If yes, complete the following information.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Name of child-care provider

 

 

 

Names of children receiving child care

 

 

 

 

 

 

 

Number of weeks provided during last calendar year

 

Estimated number of weeks of child care provided in this calendar year

 

 

 

 

 

 

Current weekly child-care cost.

Amount of child-care credit received on last year’s federal I.R.S. tax return.

 

 

 

 

 

 

 

 

 

 

Does a federal or state agency or a public or private entity contribute all or a portion of the cost of child-care services? If yes, please explain.

55.

Check the reason(s) which explain why you need child care and estimate the number of hours child care is received for each.

 

Reason

 

Estimated number of hours per week

 

 

 

Work related

 

 

 

 

 

 

 

 

 

Looking for employment

 

 

 

 

 

 

 

 

 

Enrolled in educational program to

 

 

 

 

 

 

 

 

 

improve employment opportunities

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

56.

If your reason for child care is education related, provide the following information.

 

 

 

 

 

 

Name of educational institution

 

Total classroom hours per week

 

Educational goal

 

Projected graduation date

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ADDITIONAL INFORMATION

57. List any additional information about you or the other parent that would be useful to the court in making a support recommendation. For example: education, disability, or work history.

INFORMATION REGARDING THE OTHER PARENT IN THIS CASE (if known)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

58.

Full name

 

 

 

 

 

 

 

 

59. Date of birth

 

 

60. Place of birth: city and state

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

61. Address

 

 

 

City

 

State

 

Zip

62. Home telephone

63. Work telephone

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

64.

Social security number

65. Driver’s license number

 

66. Professional license, type, and no.

67. Cell phone

68. E-mail address

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

69.

Sex

 

70. Eye color

 

71. Hair color

72. Height

 

73. Weight

 

74. Race

 

75. Scars, tattoos, etc.

 

 

M

F

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

76.

Father’s full name

 

 

 

 

 

 

77. Mother’s full maiden name

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

78.

Names of other biological/adopted minor children he/she supports

 

Birthdate

Address

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

79.

Is this party pregnant? a. When is the child due? b. Is the party in this case the biological parent of the expected child?

80. Is this party married?

 

 

Yes

No

 

 

 

 

 

Yes

No

 

 

 

 

 

 

 

Yes

No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

81.

Occupation

 

 

 

 

 

 

 

82. Employer (if unemployed, name of last employer)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

83.

Employer’s address

 

City

 

 

 

 

State

 

 

 

Zip

84. Date hired

 

 

 

 

 

 

 

 

 

 

 

 

 

85.

Gross earnings per pay period (earnings before taxes)

 

 

 

 

 

 

 

86. Average overtime hours for past 12 months.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

FOC 39 (6/17) FRIEND OF THE COURT - CASE QUESTIONNAIRE (Page 3)

Approved, SCAO

STATE OF MICHIGAN JUDICIAL CIRCUIT

COUNTY

FRIEND OF THE COURT CASE QUESTIONNAIRE (Page 4)

CASE NO.

INFORMATION REGARDING THE OTHER PARENT IN THIS CASE (continued)

87.

Medical insurance company name, address, telephone no.

 

Policy/Group number

Beginning date, if known

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

88.

Dental insurance company name, address, telephone no.

 

Policy/Group number

Beginning date, if known

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

89.

Optical insurance company name, address, telephone no.

 

Policy/Group number

Beginning date, if known

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

90.

What dependent coverage is available to the other parent without cost?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Medical

 

Dental

Optical

 

 

 

 

 

 

 

 

 

 

 

 

 

 

91.

What dependent coverage is available by payment of an additional premium? (Specify cost per pay period.)

 

 

 

 

 

 

 

Medical

 

per

Dental

per

Optical

 

per

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

92.

Individuals currently covered by other parent’s insurance

 

 

 

 

 

 

 

 

 

 

 

 

 

Name

 

 

 

 

Birthdate

Relationship

Medical ( )

Dental ( ) Optical ( )

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

If you want friend of the court services, you must check the box below.

I request child-support services pursuant to the child-support enforcement program of Title IV-D of the Social Security Act.

I declare that the information in this questionnaire is true to the best of my information, knowledge, and belief.

Date

 

Signature

Reminder List

Have you signed this questionnaire?

Have you completed item 21 regarding the number of overnights you have with the child annually? Failure to specify will result in the friend of the court estimating the number of overnights.

Have you attached your four most recent paycheck stubs, or a statement from your employer(s) of wages and deductions and year-to-date earnings?

Have you attached a copy of your last federal and state income tax returns, including all schedules, W-2s, and 1099s? If self-employed, also attach a copy of your three most recent business tax returns and/or corporation returns.

Attach any additional information that may be useful to the friend of the court in making a support recommendation. Make sure you use enough postage to cover these additional items.

Have you attached the Child Care Verification (form FOC 39e) if you are asking for reimbursement of child-care expenses?

Make a copy of this form for your own records.

Send the original form, completed and signed, to the friend of the court office.

FOC 39 (6/17) FRIEND OF THE COURT - CASE QUESTIONNAIRE (Page 4)

How to Edit Foc 39 Form Online for Free

It is simple to complete the case questionnaire courts blanks. Our PDF editor makes it practically effortless to work with any type of PDF. Down the page are the primary four steps you should follow:

Step 1: The initial step would be to click the orange "Get Form Now" button.

Step 2: The document editing page is right now available. It's possible to add information or enhance present data.

Create the case questionnaire courts PDF by typing in the details required for each area.

completing soc biweekly fill step 1

Write the necessary particulars in the Yes, Yes, Yes, and YOUR INCOME part.

Completing soc biweekly fill stage 2

The application will ask for further details in order to effortlessly prepare the box biweekly, weekly, bimonthly, monthly, married, dependents claimed, head of household, weekly, biweekly, bimonthly, monthly, Name of last full-time employer, Address of last full-time employer, Postition held at last place of, Last day employed full-time, Length of time employed in last, and Reason for leaving last full-time.

soc biweekly fill biweekly, weekly, bimonthly, monthly, married, dependents claimed, head of household, weekly, biweekly, bimonthly, monthly, Name of last full-time employer, Address of last full-time employer, Postition held at last place of, Last day employed full-time, Length of time employed in last, and Reason for leaving last full-time blanks to complete

Identify the rights and responsibilities of the parties in the section Gross earings per pay period, weekly, biweekly, bimonthly, monthly, FOC 39, (6/17) FRIEND OF THE COURT - CASE, and (Page 1).

Finishing soc biweekly fill part 4

End by checking the next areas and filling them out as required: YOUR INCOME, Commissions, Bonuses, Profit Sharing, Interest, Dividends, Annuities, Pensions/Longevity, Deferred Comp, Trust Funds, Unemp, Strike Pay, SUB Pay, Sick Benefits, Workers’ Comp, Soc, VA Benefits, Disability Insurance, GI Benefits, Nat’l Guard & Res, Armed Services, Allowance for Rent, Rental Income, Spousal Support/Alimony, State Disability Assistance, F I P, Supp, Other, If so, Yes, and Yes.

stage 5 to finishing soc biweekly fill

Step 3: Choose the "Done" button. Next, it is possible to export your PDF file - upload it to your device or deliver it via email.

Step 4: Make at least a few copies of the file to keep clear of different potential difficulties.

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