Free foc84.pmd - Michigan

Approved, SCAO

Original - Court, Part 1 1st copy - Plaintiff, Part 1 2nd copy - Defendant, Part 1

3rd copy - Friend of the court, Part 2 4th copy - Licensing agency, Part 2 5th copy - Return of service

STATE OF MICHIGAN JUDICIAL CIRCUIT COUNTY COURT CODE
Court address

CASE NO. ORDER SUSPENDING LICENSE
Court telephone no.

Plaintiff's name, address, and telephone no.

licensee

Defendant's name, address, and telephone no.

licensee

v

Attorney:

Attorney:

THE COURT FINDS: 1. The licensee a. failed to respond to a notice of proposed license suspension in a timely manner and also failed to pay the entire arrearage. b. requested a hearing based on a notice of proposed license suspension but failed to appear at the scheduled hearing and failed to pay the entire arrearage. c. failed to comply with an order for payment of arrearage. d. failed to comply with an order for payment of arrearage following a contempt finding at a show-cause hearing. e. failed to comply with a makeup and ongoing parenting-time schedule. f. failed to appear at a show-cause hearing. IT IS ORDERED: 2. Within 7 business days after receiving this order, the licensing agency shall suspend and not issue to the licensee named above a driver's/chauffeur's license an occupational license a recreational license a sporting license until further order of the court. 3. Any subsequent order rescinding this suspension is effective upon entry and payment of any customary reinstatement fee. The suspended license(s) shall be reinstated within 7 business days after receiving the rescission order and payment of the appropriate reinstatement fee by the licensee.
Date Judge Bar no.

PART 1
FOC 84 (3/09)

ORDER SUSPENDING LICENSE

MCL 552.602(h), MCL 552.629(4), MCL 552.630, MCL 552.633(2), MCL 552.635(4), MCL 552.645(1)

Approved, SCAO

Original - Court, Part 1 1st copy - Plaintiff, Part 1 2nd copy - Defendant, Part 1

3rd copy - Friend of the court, Part 2 4th copy - Licensing agency, Part 2 5th copy - Return of service

STATE OF MICHIGAN JUDICIAL CIRCUIT COUNTY COURT CODE
Court address

CASE NO. ORDER SUSPENDING LICENSE
Court telephone no.

Plaintiff's name, address, and telephone no.

licensee

Defendant's name, address, and telephone no.

licensee

v

Attorney:
Date of birth Driver's license no. Occupational license no. Known professional licenses

Attorney:
This information may be confidential under federal law and should only be distributed to the friend of the court and licensing agency.

THE COURT FINDS: 1. The licensee a. failed to respond to a notice of proposed license suspension in a timely manner and also failed to pay the entire arrearage. b. requested a hearing based on a notice of proposed license suspension but failed to appear at the scheduled hearing and failed to pay the entire arrearage. c. failed to comply with an order for payment of arrearage. d. failed to comply with an order for payment of arrearage following a contempt finding at a show-cause hearing. e. failed to comply with a makeup and ongoing parenting-time schedule. f. failed to appear at a show-cause hearing. IT IS ORDERED: 2. Within 7 business days after receiving this order, the licensing agency shall suspend and not issue to the licensee named above a driver's/chauffeur's license an occupational license a recreational license a sporting license until further order of the court. 3. Any subsequent order rescinding this suspension is effective upon entry and payment of any customary reinstatement fee. The suspended license(s) shall be reinstated within 7 business days after receiving the rescission order and payment of the appropriate reinstatement fee by the licensee.

Date

Judge

Bar no.

PART 2
FOC 84 (3/09)

ORDER SUSPENDING LICENSE

MCL 552.602(h), MCL 552.629(4), MCL 552.630, MCL 552.633(2), MCL 552.635(4), MCL 552.645(1)

Order Suspending License PROOF OF SERVICE Case No.

TO PROCESS SERVER: You must make and file your return with the court clerk. If you are unable to complete service, you must return this original and all copies to the court clerk. CERTIFICATE / AFFIDAVIT OF SERVICE / NONSERVICE OR OFFICER CERTIFICATE I certify that I am a sheriff, deputy sheriff, bailiff, appointed court officer, or attorney for a party (MCR 2.104[A][2]), and that: (notarization not required) AFFIDAVIT OF PROCESS SERVER Being first duly sworn, I state that I am a legally competent adult who is not a party or an officer of a corporate party, and that: (notarization required)

I served a copy of the order suspending license personally on: by registered or certified mail with restricted delivery (copy of return receipt attached) on:
Licensee's name Complete address of service Day, date, time

I have personally attempted to serve the order suspending license and have been unable to complete service on:
Licensee's name Complete address of service Day, date, time

I declare that the statements above are true to the best of my information, knowledge, and belief.
Signature TOTAL FEE Name (type or print) Title

Service fee

Miles traveled Fee

$ $

$ $ $

Incorrect address fee Miles traveled Fee

Subscribed and sworn to before me on My commission expires:
Date

Date

, Signature:
Deputy court clerk/Notary public

County, Michigan.

Notary public, State of Michigan, County of ACKNOWLEDGMENT OF SERVICE I acknowledge that I have received service of the order on
Day, date, time Signature

on behalf of

.

CERTIFICATE OF MAILING I certify that on this date I served a copy of this order on the parties or their attorneys and the licensing agency(ies) by first-class mail addressed to their last-known addresses as defined in MCR 3.203.
Date Signature MCR 2.105