Eaton County, MI · Eaton County
Verified Statement
This court form collects case, parent, and child information for a party who submits a verified statement to the Friend of the Court.
At a glance
- Issued by
- City of Eaton County · Eaton County, Eaton County, Michigan
- Notarization
- Not required: file this form without a notary.
- Official source
- courts.michigan.gov
- Blank form
- Download the PDF
- Catalogued
- Machine-readable
- JSON record · about the forms index
What this form is
The Verified Statement records identifying, contact, employment, income, and public assistance information for you and the other parent, along with details about minor children and available health coverage. The form is for a Friend of the Court case and is distributed to the Friend of the Court and the parties or their attorneys. It also directs you to notify the Friend of the Court in writing if your public assistance information changes before judgment.
Who needs it
A party in a Friend of the Court case completes this form with information about themselves, the other parent, and the minor children.
How to submit it
The form lists distribution to the Friend of the Court and the plaintiff or defendant, or their attorneys, and provides a blank for the Friend of the Court address. It does not specify a submission method.
About notarization
This form is signed and dated without a notary; it includes a declaration under penalties of perjury, and child support services require a separate DHS-1201D form.
How to submit this form
- 1
Download the Form
Download the Verified Statement PDF.
- 2
Complete the Form
Provide the requested information about yourself, the other parent, and the minor children.
- 3
Sign and Date
Sign and date the declaration under penalties of perjury.
- 4
Distribute the Form
Use the distribution instructions for the Friend of the Court and the parties or their attorneys.
Frequently asked questions
- What information does the Verified Statement ask for?
- It asks for identifying, contact, employment, income, and public assistance details for both parents, plus information about minor children, health coverage, and possible caregivers.
- Who completes the Verified Statement?
- A party in a Friend of the Court case completes the form. It includes sections for information about the person completing it, the other parent, and minor children.
- Do I need a notary for the Verified Statement?
- No. The form calls for a signature and date, and includes a declaration under penalties of perjury; it does not require notarization.
- How do I submit the Verified Statement?
- The form lists distribution to the Friend of the Court and the parties or their attorneys, with a space for the Friend of the Court address. It does not specify a submission method.