Approved, SCAO
Original - Court 1st copy - Plaintiff 2nd copy - Defendant 3rd copy - SCAO
STATE OF MICHIGAN JUDICIAL CIRCUIT COUNTY
Court address
CASE NO. DISMISSAL OF PRISONER CIVIL ACTION, Frivolous Action
Court telephone no.
Plaintiff's name and address
Defendant's name and address
v
Prisoner number Plaintiff's attorney, bar no., address, and telephone no. Defendant's attorney, bar no., address, and telephone no.
THE COURT FINDS: 1. The plaintiff filed a complaint on
Date
concerning prison conditions.
2. The plaintiff was determined indigent and unable to pay the filing fee and costs required by law. The full filing fee of $ An attorney was appointed. 3. The plaintiff was determined indigent and shall pay the filing fee and costs as required by MCL 600.2963. 4. Total unpaid fees and costs to date are $ 5. The complaint or a portion of the complaint is frivolous as follows: . was waived. The partial filing fee of $ was waived.
IT IS ORDERED: 6. The civil action is dismissed with prejudice as a frivolous action, and the following unpaid fees and costs shall be paid by the plaintiff in accordance with this order. Filing Fee Other Costs (specify) Attorney Fees Total $ $ $ $ 0.00
Payments toward the unpaid fees and costs shall be as follows:
7. The good time/disciplinary credits accumulated by the plaintiff as of Date the following amount. All. All up to days.
shall be forfeited in
Date
Judge
Bar no.
A copy of this order shall be promptly mailed to the State Court Administrative Office.
CC 78 (3/08)
DISMISSAL OF PRISONER CIVIL ACTION, Frivolous Action
MCL 600.5501 et seq., MCL 800.33 et seq.