Michigan Form Dch 0838 is a Declaration of Domicile for Michigan Income Tax Purposes. This form is used to declare your domicile status for Michigan income tax purposes. A person's domicile is their permanent home, the place where they intend to return to whenever they are away. There are a number of factors that can be considered when determining your domicile, including your residency, presence in Michigan, and ties to the state. To complete this form, you will need to provide information about your residency and presence in Michigan, as well as any ties you have to the state. Once you have completed the form, it must be signed and dated. You should keep a copy of this form for your records.
In the listing, there is some information relating to the michigan form dch 0838. It may be helpful to know its length, the average time to complete the form, the fields you should fill in, and so on.
| Question | Answer |
|---|---|
| Form Name | Michigan Form Dch 0838 |
| Form Length | 1 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 15 sec |
| Other names | dch 0838 fillable, michigan record divorce, dch 0838, record of divorce michigan |
__________________________________
State File Number
RECORD OF
DIVORCE OR ANNULMENT
MICHIGAN DEPARTMENT OF HEALTH AND HUMAN SERVICES
By authority of MCL 333.2813.
_________________________________
Court Case Number
_________________________________
County
1. Plaintiff’s Full Name _______________________________________________________ 2. |
Plaintiff’s Birthdate ______________ |
||||
□ |
Male |
□ |
Female |
(First, Middle, Last) |
(Month, Day, Year) |
|
|
||||
3.Last Name Before First Married (if different) _____________________________________________________________________
4.Plaintiff’s Residence _______________________________________________________________________________________
(City, Village, or Township)(County)(State)
5. |
Plaintiff’s Birthplace ______________________________________________________ 6. Number of this Marriage __________ |
|||||
|
|
|
|
|
(State or Foreign Country) |
(First, Second, etc. - Specify) |
7. |
Defendant’s Full Name ____________________________________________________ 8. Defendant’s Birthdate ____________ |
|||||
|
□ |
Male |
□ |
Female |
(First, Middle, Last) |
(Month, Day, Year) |
9.Last Name Before First Married (if different) _____________________________________________________________________
10.Defendant’s Residence _____________________________________________________________________________________
(City, Village, or Township)(County)(State)
11. Defendant’s Birthplace ___________________________________________________ 12. Number of this Marriage __________
|
|
(State or Foreign Country) |
|
(First, Second, etc. - Specify) |
||
13. |
Place of this Marriage ______________________________________________________________________________________ |
|||||
|
(City, Village, or Township) |
(County) |
□ |
(State or Foreign Country) |
||
|
|
|
|
|
||
14. |
Date of this Marriage _____________________ |
15. Date Couple Last Resided |
Check if Not |
|
|
|
Separated |
______________ |
|||||
in Same Household |
||||||
|
(Month, Day, Year) |
□ |
(Month, Day, Year) |
|||
|
|
|
|
|
||
|
|
|
Check If |
|
|
|
16. |
Number of Minor Children in Household at Separation Date (Filing Date if Not Separated) |
None |
______________ |
|||
|
|
|
|
(Number) |
|
|
17. |
Plaintiff’s Attorney _________________________________________________________________________________________ |
|||||
|
|
(Name - Type or Print) |
(Bar Number) |
|
||
18. |
Attorney’s Address _________________________________________________________________________________________ |
|||||
|
(Number and Street) |
(City) |
(State) |
(Zip Code) |
|
|
|
20. Number of Minor Children Whose |
|
|
|
||
19. |
Judgment of ____________________ Physical Custody was Awarded to: Plaintiff____ Defendant____ Joint____ Other____ |
|||||
|
(Divorce/Annulment - Specify) |
(Number) |
(Number) |
(Number) |
(Number) |
|
|
|
□ No Children |
□ Unknown |
|
|
|
21. |
Judgment Recorded on _______________________ 22. I certify that this Divorce was granted on ________________________ |
|||||
|
(Month, Day, Year) |
|
(Month, Day, Year) |
|
||
23. |
Certifying Oficial _________________________________________________________________________________________ |
|||||
|
(Signature) |
(Title) |
(Date Signed) |
|
||
Failure to provide the required information is a misdemeanor punishable by imprisonment
of not more than 1 year or a ine of not more than $1,000.00 or both.