State of Michigan department of HEALTH AND human services Lansing GRETCHEN WHITMER governor ELIZABETH HERTEL director
Notice of Discharge of State-Owed Debt
Date:
To:
Docket(s)	County Friend of the Court Office
The Friend of the Court (FOC) office has approved your request for the discharge (forgiveness or waiver) of your state-owed debt on the above docket(s), based upon the information you provided on the Request to Discharge State-Owed Debt (DHS-681/FEN681), Request for “Matching” Payment (DHS-682/ FEN682), or other documentation.
Amount of state-owed debt discharged	Date of adjustment
$
Reason for discharge:
You have been in an extremely difficult circumstance; unable to pay state-owed debt.
You made a one-time lump-sum payment, and the state “matched” the payment by adjusting state-owed debt.
The other parent or custodian waived (forgave) debt owed jointly to himself/herself and to the state; therefore, the state’s interest in that debt is also waived.
You and the other parent have married.
Please note that if any of your state-owed debt is discharged based on incorrect, incomplete, or false information you provided, the FOC may reinstate the debt forgiven (add it back to the total amount owed in support). If you have any questions, please contact the FOC office identified above.
The Michigan Department of Health and Human Services will not exclude from participation in, deny benefits of, or discriminate against any individual or group because of race, sex, religion, age, national origin, color, height, weight, marital status, gender identification or expression, sexual orientation, partisan considerations, or a disability or genetic information that is unrelated to the person’s eligibility.