Approved, SCAO
Original - Court 1st copy - Defendant 2nd copy - Prosecutor 3rd copy - Defendant (order)
STATE OF MICHIGAN JUDICIAL DISTRICT
Court address
CLAIM OF APPEAL OF RIGHT/ REQUEST TO WITHDRAW ADMISSION AND ORDER, Civil Infraction
CASE NO.
Court telephone no.
Plaintiff
Defendant's name and address
The of
State
Township
City
Village
v
Statute
Ordinance
Infraction:
Infraction date:
SECURITY FOR APPEAL/REQUEST TO WITHDRAW ADMISSION This is the plaintiff's appeal; no security is required. Bond is set at $ Fine and costs of $ . Bond was posted were paid on
Date Date
. .
CLAIM OF APPEAL OF RIGHT Plaintiff Defendant claims an appeal from the judgment entered on
Date
in this court, by the
traffic bureau.
magistrate.
district judge.
Date
Applicant signature Address City, state, zip
REQUEST TO WITHDRAW ADMISSION Defendant requests to withdraw the admission entered on
Date
in this court, by the
traffic bureau.
magistrate.
district judge.
Date
Defendant signature Address City,state, zip
ORDER REGARDING REQUEST TO WITHDRAW ADMISSION IT IS ORDERED the defendant's request to withdraw is
Date CIA 05 (4/08)
granted.
Judge/Magistrate
denied.
MCR 4.101(G), (H)(3)
CLAIM OF APPEAL OF RIGHT/REQUEST TO WITHDRAW ADMISSION AND ORDER, Civil Infraction