Approved, SCAO
STATE OF MICHIGAN
JUDICIAL DISTRICT JUDICIAL CIRCUIT COUNTY PROBATE Court address
CASE NO. REMITTAL OF DISQUALIFICATION
Court telephone no.
Plaintiff name(s) and address(es)
Defendant name(s) and address(es)
v
Plaintiff's attorney, bar no., address, and telephone no.
Defendant's attorney, bar no., address, and telephone no.
1. Judge
Bar no.
is willing to
participate in the proceedings regarding this matter and has requested that the parties consider waiving disqualification under MCR 2.003(D). The judge has no personal bias or prejudice concerning a party in the matter. 2. The possible grounds for disqualification are:
3. The parties, without participation by the judge, all agree that the judge should not be disqualified.
Date
Judge
Date
Plaintiff signature/Attorney for plaintiff
Bar no.
Date
Plaintiff signature/Attorney for plaintiff
Bar no.
Date
Defendant signature/Attorney for defendant
Bar no.
Date
Defendant signature/Attorney for defendant
Bar no.
MC 272 (9/00)
REMITTAL OF DISQUALIFICATION
MCR 2.003(D)