Collection Report Form

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Complete the form and click “submit”. Report forms are due by the 10th of each month

Name *

Case Number *

Phone Number *

Mailing Address *

City *

State *

Zip Code *

Are you employed? *

Yes

If yes, name of Employer?

Employer's Address

Employer's City

Employer's State

Employer's Zip Code

Do you have a wage assignment? *

Yes

Did you make a payment today? *

Yes

If no, explain?

Do you want to enter into a wage assignment? *

Yes

If yes, how much PER PAY would you like sent to the court by your employer?

Any information you would like the magistrate to know regarding your current financial situation

NOTE: This temporary procedure has been put in place for your protection. Failure to report to me by completing the form EACH MONTH until your fines/costs are paid in full may subject you to an order to show cause and additional penalties, including possible suspension of your driver’s license and a bench warrant issued for your arrest. If you need to speak to the magistrate or have a question, please call 989-672-3790 during business hours to speak to someone directly.

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