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Juvenile Affidavit and Financial Statement

The following affidavit has to be completed and submitted in print with both its pages signed. Supporting documents have to be submitted along with the complete copy of this affidavit.

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Juvenile Division 
Affidavit and Financial Statement  
 	
Submitting the Affidavit and Financial Statement   	
 
1.  Complete  Form 128-3CC – AFFIDAVIT AND FINANCIAL STATEMENT,  print 
and sign both pages.   
 
2.  SUPPORTING DOCUMENTATION must be submitted with the Affidavit and 
Financial Statement:  
    
•  A copy of valid ID, with the current address  
•   Two (2) Pay stubs   
•   W2 form(s)  
•   Entitlement Verification (proof of Government Benefits)  	
 
 
 	
Note:   
You may be ordered to reimburse the Court in full for cost 
associated with this case if the proper documentation is not 
submitted with the Affidavit and Financial Statement.	 	
 
 
 
Return by : 
Email:   tccu@3rdcc.org	
 	
Fax:     (313) 237 -9226 
Mail:    T hird Judicial Circuit of Michigan  
Collections Unit  
1025 E. Forest  
Building B, Room 139  
Detroit, MI  48207  
 
If you have any question s, contact Wayne County Collections Unit  
(313) 833 -0798 
 
 
Form 138 ONLINE FINANCIAL STAT EMENT Coversheet -JUV
Next: Job Affidavit Previous: js044 Civil Cover Sheet
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