Mc 52 Form PDF Details

Navigating the world of Medicare can be confusing, especially when you encounter forms that you don't recognize. One such form is the MC 52, also known as a "Request for Hearing by Administrative Law Judge". While it may appear daunting, this form is an important tool available to anyone disputing a decision from the Centers for Medicare and Medicaid Services (CMS). Below we'll discuss what exactly an MC 52 form is and how to properly complete it so that your appeal will have a higher chance at success.

QuestionAnswer
Form NameMc 52 Form
Form Length4 pages
Fillable?No
Fillable fields0
Avg. time to fill out1 min
Other namesmichigan mc garnishment, mc 52 writ garnishment, request writ garnishment, michigan mc 52

Form Preview Example

 

 

 

Original - State Treasurer (Part 1)

 

Approved, SCAO

1st copy - Court (Part 2)

3rd copy - Return (proof of service) (Part 2)

2nd copy - Defendant (Part 2)

4th copy - Plaintiff/Attorney (proof) (Part 2)

• STATE OF MICHIGAN

REQUEST AND WRIT FOR GARNISHMENT

• CASE NO.

 

 

JUDICIAL DISTRICT

 

 

 

(INCOMETAXREFUND/CREDIT)

 

 

 

JUDICIAL CIRCUIT

 

 

 

 

 

 

 

 

 

 

Court address

• Zip code

Court telephone no.

•

•

•

•

•

•

Plaintiff's name and address (judgment creditor)

Plaintiff FE no. / Social security no.

Plaintiff's attorney, address

Plaintiff attorney FE no.

Plaintiff attorney telephone no.

 

•

 

 

•

v

•

Defendant's name and address (judgment debtor)

Social security no.

Garnishee

Third Party Withholding Unit

MichiganDepartmentofTreasury

PO Box 30785

Lansing, Michigan 48909

•

•

REQUEST

NOTE for item 2: If a civil judgment includes judgment interest in the “total judgment” field (as in the forms in use before the 5/07 revisions),

 

 

 

the interest amount reported in item 2 should not include any postfiling interest already included in the judgment.

 

 

 

 

 

 

 

 

 

1.

On

 

 

 

, the plaintiff received judgment against the defendant for:

$

 

 

 

 

.

2.

The total amount of judgment interest accrued to date is:

 

 

 

$

 

 

 

 

.

 

The total amount of postjudgment costs accrued to date is:

 

 

 

$

 

 

 

 

.

 

The total amount of postjudgment payments made and credits to date is:

 

$

 

 

 

 

.

 

The amount of the unsatisfied judgment now due (including interest and costs) is:

$

 

 

 

.

3.

Plaintiffknowsorwithgoodreasonbelievesthegarnisheeisindebtedtoorpossessesorcontrolspropertybelongingtodefendant.

4.

Plaintiff requests a writ of income tax garnishment be paid to

plaintiff,

plaintiff's attorney,

the court,

 

andmailedto

plaintiff.

plaintiff'sattorney.

thecourt.

 

 

 

 

 

 

 

I declare under the penalties of perjury that this request has been examined by me and that its contents are true to the best of my information,knowledge,andbelief.

Date

Plaintiff/Agent/Attorney signature

WRIT OF GARNISHMENT

To be completed by the court.

TO THE PLAINTIFF:

1.The social security number field is blacked out for security reasons on all parts except the garnishee copy.

2.You must serve this writ on the state treasurer along with a $6.00 fee and any discovery request for information related to this garnishment.

3.You must serve a copy of this writ on the defendant within 7 days after serving the writ on the state treasurer.

4.You are responsible for paying to the state treasurer any reasonable costs incurred by the state treasurer in providing information in response to your discovery request.

5.If a state tax refund or credit is not intercepted before October 31 of the year during which this writ of garnishment is to be

processed, you will not receive a disclosure unless you file a written request with the state treasurer between November 1 and December 31 of the tax year following the tax year for which this writ was filed.

TO THE DEFENDANT: See separate instructions.

1.If a state tax refund or credit is intercepted pursuant to this writ, the state treasurer will notify you on a disclosure form.

2.You have 14 days after being notified of an intercept to file objections to the writ of garnishment with the court. If you do not object within this time, the intercepted tax refund or credit held under this writ will be applied to the judgment 28 days after the disclosure was filed with the court.

TOTHEGARNISHEE:

1.Upon intercepting a state tax refund or credit, calculate the amount available to satisfy all or part of the garnishment.

2.Within 90 days after establishing any other liability for which the state tax refund or credit may be applied under MCL 205.30a, file with the court a verified disclosure identifying the intercepted amount, less any setoff, counterclaim, or other demand of the state against the defendant.

3.Unless notified by the court that objections to the writ of garnishment have been filed, payment of the intercepted amount must be made not less than 28 days after filing the disclosure.

4.You are ordered to pay the amount intercepted under this writ as specified in the request.

Date of issue

 

 

Deputy court clerk

 

MC 52 (10/19)

REQUEST AND WRIT FOR GARNISHMENT (INCOME TAX REFUND/CREDIT) (Part1) MCL 600.4061, MCL 600.4061a

 

 

 

Original - State Treasurer (Part 1)

 

Approved, SCAO

1st copy - Court (Part 2)

3rd copy - Return (proof of service) (Part 2)

2nd copy - Defendant (Part 2)

4th copy - Plaintiff/Attorney (proof) (Part 2)

• STATE OF MICHIGAN

REQUEST AND WRIT FOR GARNISHMENT

• CASE NO.

 

 

JUDICIAL DISTRICT

 

 

 

(INCOMETAXREFUND/CREDIT)

 

 

 

JUDICIAL CIRCUIT

 

 

 

 

 

 

 

 

 

 

Court address

• Zip code

Court telephone no.

•

•

•

•

•

Plaintiff's name and address (judgment creditor)

Plaintiff FE no. / Social security no.

Plaintiff's attorney, address

Plaintiff attorney FE no.

•Plaintiff attorney telephone no.

•

v

•

Defendant's name and address (judgment debtor)

Garnishee Third Party Withholding Unit

MichiganDepartmentofTreasury

PO Box 30785

Lansing, Michigan 48909

REQUEST

NOTE for item 2: If a civil judgment includes judgment interest in the “total judgment” field (as in the forms in use before the 5/07 revisions), the interest amount reported in item 2 should not include any postfiling interest already included in the judgment.

1.

On

 

, the plaintiff received judgment against the defendant for:

$

 

 

 

.

2.

The total amount of judgment interest accrued to date is:

$

 

 

 

.

 

 

 

The total amount of postjudgment costs accrued to date is:

$

 

 

 

.

 

 

 

•

The total amount of postjudgment payments made and credits to date is:

$

 

 

 

.

 

 

The amount of the unsatisfied judgment now due (including interest and costs) is:

$

 

 

.

 

 

3.

Plaintiffknowsorwithgoodreasonbelievesthegarnisheeisindebtedtoorpossessesorcontrolspropertybelongingtodefendant.

• 4.

Plaintiff requests a writ of income tax garnishment be paid to

plaintiff,

plaintiff's attorney,

the court,

 

andmailedto

plaintiff.

plaintiff'sattorney.

thecourt.

 

 

I declare under the penalties of perjury that this request has been examined by me and that its contents are true to the best of my information,knowledge,andbelief.

Date

Plaintiff/Agent/Attorney signature

WRIT OF GARNISHMENT

To be completed by the court.

TO THE PLAINTIFF:

1.The social security number field is blacked out for security reasons on all parts except the garnishee copy.

2.You must serve this writ on the state treasurer along with a $6.00 fee and any discovery request for information related to this garnishment.

3.You must serve a copy of this writ on the defendant within 7 days after serving the writ on the state treasurer.

4.You are responsible for paying to the state treasurer any reasonable costs incurred by the state treasurer in providing information in response to your discovery request.

5.If a state tax refund or credit is not intercepted before October 31 of the year during which this writ of garnishment is to be

processed, you will not receive a disclosure unless you file a written request with the state treasurer between November 1 and December 31 of the tax year following the tax year for which this writ was filed.

TO THE DEFENDANT: See separate instructions.

1.If a state tax refund or credit is intercepted pursuant to this writ, the state treasurer will notify you on a disclosure form.

2.You have 14 days after being notified of an intercept to file objections to the writ of garnishment with the court. If you do not object within this time, the intercepted tax refund or credit held under this writ will be applied to the judgment 28 days after the disclosure was filed with the court.

TOTHEGARNISHEE:

1.Upon intercepting a state tax refund or credit, calculate the amount available to satisfy all or part of the garnishment.

2.Within 90 days after establishing any other liability for which the state tax refund or credit may be applied under MCL 205.30a, file with the court a verified disclosure identifying the intercepted amount, less any setoff, counterclaim, or other demand of the state against the defendant.

3.Unless notified by the court that objections to the writ of garnishment have been filed, payment of the intercepted amount must be made not less than 28 days after filing the disclosure.

4.You are ordered to pay the amount intercepted under this writ as specified in the request.

Date of issueDeputy court clerk

MC 52 (10/19) REQUEST AND WRIT FOR GARNISHMENT (INCOME TAX REFUND/CREDIT) (Part2) MCL 600.4061, MCL 600.4061a

Instructions for the Defendant

1.This writ has been issued because there is a judgment against you that you have not paid. In order to collect on this judgment, income owed to you may be withheld or property belonging to you may be taken from you and sold.

2.You may object to this garnishment if:

a.your income is exempt from garnishment by law,

b.you have a pending bankruptcy proceeding,

c.the maximum withheld exceeds the amount allowed by law,

d.you have paid the judgment in full,

e.the garnishment was not properly issued or is otherwise invalid.

3.Except for tax garnishments issued in criminal cases, you may send the plaintiff a written request to review postjudgment costs and fees listed in item 2 of the request. Within 28 days after receiving your request, the plaintiff must send an itemized list of the postjudgment costs and fees to you and the court. Within 28 days after receiving the itemized list, you may file a motion with the court to review the postjudgment costs and fees if you believe they are wrong. If the judge rules in your favor, the judge may order the motion fee to be deducted from the judgment balance.

REQUEST AND WRIT FOR GARNISHMENT (INCOME TAX REFUND/CREDIT)

Case No.

PROOF OF SERVICE

TO PROCESS SERVER: You must serve the garnishee with this request and writ of garnishment, the $6.00 fee, and any attachments, and file proof of service with the court clerk as directed by the plaintiff. If you are unable to complete service, you must return this original and all copies to the court clerk.

CERTIFICATE / AFFIDAVIT OF SERVICE / NONSERVICE

 

 

OFFICER CERTIFICATE

OR

 

AFFIDAVIT OF PROCESS SERVER

I certify that I am a sheriff, deputy sheriff, bailiff, appointed

Being first duly sworn, I state that I am a legally competent

court officer, or attorney for a party [MCR 2.104(A)(2)], and

adult who is not a party or an officer of a corporate party, and

that:

(notarization not required)

 

 

that:

(notarization required)

 

 

 

 

I served the request and writ of garnishment, the $6.00 fee, and any attachments by:

 

 

personal service

registered or certified mail (copy of return receipt attached) on:

 

 

 

 

 

 

 

Garnishee name

 

Complete address of service

 

Day, date, time

 

 

MichiganDepartmentofTreasury

PO Box 30785

 

 

 

 

 

Third Party Withholding Unit

 

Lansing, Michigan 48909

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

I served a copy of the request and writ of garnishment by

 

 

 

 

 

personalservice

first-class mail on:

 

 

 

Defendant name

Complete address of service

Day, date, time

Ihavepersonallyattemptedtoservetherequestandwritofgarnishmentonthedefendantandhavebeenunabletocompleteservice.

Defendant name

Complete address(es) of service

Day, date, time

I declare under the penalties of perjury that this certificate has been examined by me and that its contents are true to the best of my information,knowledge,andbelief.

Service fee

Miles traveled Fee

$

 

$

 

Incorrect address fee

Miles traveled Fee

TOTAL FEE

$

 

$

 

$

 

 

 

 

Signature

Name (type or print)

Title

Subscribed and sworn to before me on

 

 

 

 

 

 

 

.

 

 

Date

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Deputy clerk/Notary public signature

 

 

My commission expires:

 

 

 

 

 

 

 

 

Date

 

Name (type or print)

 

 

Notary public, State of Michigan, County of

 

 

 

.

Acting in the County of

 

 

.

This notarial act was performed using an electronic notarization system or a remote electronic notarization platform

 

 

ACKNOWLEDGMENT OF SERVICE

I acknowledge that I have received the request and writ of garnishment (and the $6.00 fee and attachments if applicable) on

.

Day, date, time

on behalf of

Signature

MCR2.105

 

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For you to complete this form, ensure that you enter the required details in each and every blank:

1. It is advisable to fill out the mc 52 writ garnishment correctly, so take care when filling in the areas comprising all these fields:

Completing segment 1 in mi writ

2. The next part is usually to submit all of the following fields: I declare under the penalties of, Date WRIT OF GARNISHMENT TO THE, To be completed by the court, PlaintiffAgentAttorney signature, The social security number field, this garnishment, You must serve a copy of this, information in response to your, If a state tax refund or credit, processed you will not receive a, TO THE DEFENDANT See separate, If a state tax refund or credit, not object within this time the, TO THE GARNISHEE, and Upon intercepting a state tax.

Step number 2 in filling out mi writ

3. This third part should also be quite simple, You are ordered to pay the amount, Date of issue MC REQUEST AND, and Deputy court clerk - every one of these blanks will need to be filled out here.

Part # 3 in completing mi writ

4. The fourth part comes next with the next few fields to complete: cid, cid cid cid cid, cid, cid, Approved SCAO, cid, STATE OF MICHIGAN, JUDICIAL DISTRICT JUDICIAL CIRCUIT, Court address, Plaintiffs name and address, Plaintiff FE no Social security no, Plaintiffs attorney address, Plaintiff attorney FE no, Plaintiff attorney telephone no cid, and Original State Treasurer Part st.

The way to fill out mi writ part 4

5. Last of all, this final segment is precisely what you will have to wrap up prior to submitting the PDF. The blank fields you're looking at include the next: cid, Plaintiff knows or with good, plaintiff, plaintiffs attorney, the court, and mailed to, plaintiff, plaintiffs attorney, the court, I declare under the penalties of, Date WRIT OF GARNISHMENT TO THE, To be completed by the court, PlaintiffAgentAttorney signature, The social security number field, and this garnishment.

Writing segment 5 in mi writ

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