INFORMATION
FELONY
 AMENDED

                                                             Defendant’s name and address
THE PEOPLE OF THE
STATE OF MICHIGAN 

  v 

Codefendant(s) (if known)

Victim or complainant

Complaining witness

Date: On or about

City/Twp./Village

County in Michigan Defendant TCN

Defendant CTN

Defendant SID

Defendant DOB

Put DOB in Ref. No. row 1 on MC 97

 Put DLN on Ref. No. row 3 on MC 97

Defendant DLN
 

 Oper./Chauf.

 CDL

Police agency report no.

Charge

Maximum penalty

Vehicle Type

Defendant Sex

Defendant Race

 A sample for chemical testing for DNA identification profiling is on file with the Michigan State Police from a previous case.

Witnesses

STATE OF MICHIGAN, COUNTY OF 
 
IN THE NAME OF THE PEOPLE OF THE STATE OF MICHIGAN: The prosecuting attorney for this county appears before 
the court and informs the court that on the date and at the location described, the defendant:

 .

and against the peace and dignity of the State of Michigan.
 

                     

 Prosecuting Attorney

Date

 

 By: 
 

STATE OF MICHIGANJUDICIAL DISTRICTJUDICIAL CIRCUIT JUDGEDISTRICT CASE NO.CIRCUIT CASE NO.Court addressCourt telephone no.District Court ORI: MI-Circuit Court ORI: MI-Approved, SCAOForm MC 200s, Rev. 9/22MCL 764.1 et seq., MCL 766.1 et seq., MCL 767.1 et seq., MCR 6.112(D)Page 1 of 1Distribute form to: CourtProsecutorDefendantCOMPLAINT
FELONY
 AMENDED

                                                             Defendant’s name and address
THE PEOPLE OF THE
STATE OF MICHIGAN 

  v 

Codefendant(s) (if known)

Victim or complainant

Complaining witness

Date: On or about

City/Twp./Village

County in Michigan Defendant TCN

Defendant CTN

Defendant SID

Defendant DOB

Put DOB in Ref. No. row 1 on MC 97

 Put DLN on Ref. No. row 3 on MC 97

Defendant DLN
 

 Oper./Chauf.

 CDL

Police agency report no.

Charge

Maximum penalty

Vehicle Type

Defendant Sex

Defendant Race

 A sample for chemical testing for DNA identification profiling is on file with the Michigan State Police from a previous case.

Witnesses

STATE OF MICHIGAN, COUNTY OF 
 

 .

The complaining witness says that on the date and at the location described, the defendant, contrary to law,

 The complaining witness asks that defendant be summoned and dealt with according to law.

Summons authorized on 

Date

 by:

I  declare  under  the  penalties  of  perjury  that  this  complaint  has  been 
examined  by  me  and  that  its  contents  are  true  to  the  best  of  my 
information, knowledge, and belief.

Prosecuting official

  

 

 

 

 

 

 

 

 

 

 

 Security for costs posted

Date

Complaining witness signature

STATE OF MICHIGANJUDICIAL DISTRICTJUDICIAL CIRCUIT JUDGEDISTRICT CASE NO.CIRCUIT CASE NO.Court addressCourt telephone no.District Court ORI: MI-Circuit Court ORI: MI-Approved, SCAOForm MC 200s, Rev. 9/22MCL 764.1 et seq., MCL 766.1 et seq., MCL 767.1 et seq., MCR 6.101, MCR 6.102Page 1 of 1Distribute form to: CourtProsecutorDefendantSUMMONS
FELONY

                                                             Defendant’s name and address
THE PEOPLE OF THE
STATE OF MICHIGAN 

  v 

Codefendant(s) (if known)

Victim or complainant

Complaining witness

Date: On or about

City/Twp./Village

County in Michigan Defendant TCN

Defendant CTN

Defendant SID

Defendant DOB

Put DOB in Ref. No. row 1 on MC 97

 Put DLN on Ref. No. row 3 on MC 97

Defendant DLN
 

 Oper./Chauf.

 CDL

Police agency report no.

Charge

Maximum penalty

Vehicle Type

Defendant Sex

Defendant Race

 A sample for chemical testing for DNA identification profiling is on file with the Michigan State Police from a previous case.

Witnesses

STATE OF MICHIGAN, COUNTY OF 
 

 .

The complaining witness has filed a sworn complaint in this court stating that on the date and the location described, the 
defendant, contrary to law,

THE COURT FINDS probable cause to believe the defendant committed the offense(s) set forth.
IN THE NAME OF THE PEOPLE OF 

 
 
TAKE NOTICE:  YOU ARE SUMMONED TO APPEAR for arraignment on 

 THE STATE OF MICHIGAN 

Date and time

 

 
     

 the address above 

at 
 
before the presiding judge. If you fail to appear, a warrant may be issued for your arrest. This summons expires on the 
date of hearing. If you require accommodations to use the court because of a disability or if you require a foreign language 
interpreter to help you fully participate in court proceedings, please contact the court immediately to make arrangements.

 
Location

 , Michigan, 

 

 

 

                                                                                          Judge/Magistrate signature and date

 

 
 

 

STATE OF MICHIGANJUDICIAL DISTRICTJUDICIAL CIRCUIT JUDGEDISTRICT CASE NO.CIRCUIT CASE NO.Court addressCourt telephone no.District Court ORI: MI-Circuit Court ORI: MI-Approved, SCAOForm MC 200s, Rev. 9/22MCL 764.1 et seq., MCL 766.1 et seq., MCL 767.1 et seq., MCR 6.102, MCR 6.103Page 1 of 1Distribute form to: CourtProsecutorDefendantPROOF OF SERVICE

Case No. 
 

TO PROCESS SERVER:  You must serve the copies of the summons, complaint, and any attachments and file proof of 
service with the court clerk. If you are unable to complete service, you must return this original and all copies to the court 
clerk.

CERTIFICATE OF SERVICE / NONSERVICE / MAILING

 I served 

 

 personally 

 

 by first-class mail to the defendant’s last known address

  a copy of the summons and complaint, together with the attachments listed below on: 

 I have attempted to serve the summons and complaint, together with the attachments listed below, and 

  have been unable to complete service on:

Defendant’s/Household member’s name

Date and time of service

Place or address of service

Attachments (if any)

I declare under the penalties of perjury that this proof of service has been examined by me and that its contents are true to 
the best of my information, knowledge, and belief.
 
Service fee

  
Signature

                     

Miles traveled

  

$
 

                     
Incorrect address fee
                     

$

 

Miles traveled

Fee
$

Fee
$

TOTAL FEE

$

  

  

  
Name (type or print)

  
Title (if applicable)

I acknowledge that I have received service of the summons and complaint, together with 

ACKNOWLEDGMENT OF SERVICE

Attachments

Signature

 on 

Date and time

 on behalf of 

 

CERTIFICATE OF MAILING BY COURT OR PROSECUTOR

I certify that on this date I served a copy of this summons and complaint, together with any attachments on the defendant by 
first-class mail addressed to his or her last known address as defined in MCR 2.107(C)(3). I declare under the penalties of 
perjury that this certificate of mailing has been examined by me and that its contents are true to the best of my information, 
knowledge, and belief.
 

                     

 

                                                                                           Court Clerk/Prosecutor signature and date

BINDOVER/TRANSFER AFTER
PRELIMINARY EXAMINATION
FELONY

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

 .

 .

                                                             Defendant’s name and address
THE PEOPLE OF THE
STATE OF MICHIGAN 

  v 

Codefendant(s) (if known)

Victim or complainant

Complaining witness

Date: On or about

City/Twp./Village

County in Michigan Defendant TCN

Defendant CTN

Defendant SID

Defendant DOB

Put DOB in Ref. No. row 1 on MC 97

 Put DLN on Ref. No. row 3 on MC 97

Defendant DLN
 

 Oper./Chauf.

 CDL

Police agency report no.

Charge

Maximum penalty

Vehicle Type

Defendant Sex

Defendant Race

 A sample for chemical testing for DNA identification profiling is on file with the Michigan State Police from a previous case.

Date: 
  

                          District judge: 

Reporter/Recorder                                                                          Cert. no.

 
Represented by counsel                                                             Bar no.

EXAMINATION WAIVER

1.  I, the defendant, understand:
  a.  I have a right to employ an attorney.
  b.  I may request an appointed attorney if I am financially unable to employ one.
 
 
2.  I voluntarily waive my right to a preliminary examination and understand that I will be bound over to circuit court on the 
 

c.  I have a right to a preliminary examination where it must be shown that a crime was committed and probable cause exists
    to charge me with the crime.

charges in the complaint and warrant (or as amended).

 at 

Time

    

 Posted

 4.  Examination was held on 
 
    that an offense not cognizable by the district court has been committed and that the defendant committed the offense.

 and it was found that probable cause exists to believe both 

 Date

 

Defendant attorney                                                                           Bar no.

Defendant

 

I consent to this waiver: 

Prosecuting attorney                                                                                         Bar no.

 3.  Examination was waived on 

Date

ADULT BINDOVER

 .

 MCL/PACC Code 

 

 5.  The defendant is bound over to circuit court to appear on 

Date

 on the charge(s) in the complaint.
 on the amended charge(s) of

.  Bond is set in the amount of $ 

 . Type of bond: 

 

 

 

   
   
 

     

 

 

     

 
 

 
 

 
 
 

  6

 

                                                                                          Judge signature and date

STATE OF MICHIGANJUDICIAL DISTRICTJUDICIAL CIRCUIT JUDGEDISTRICT CASE NO.CIRCUIT CASE NO.Court addressCourt telephone no.District Court ORI: MI-Circuit Court ORI: MI-Approved, SCAOForm MC 200s, Rev. 9/22MCL 766.14(2), MCR 6.110, MCR 6.911Page 1 of 2Distribute form to: CourtProsecutorDefendantCase No. 
 

 3. Examination was waived on 

 .

JUVENILE BINDOVER/TRANSFER

 4. Examination was held on 

 and it was found that

Date

Date

 there is probable cause that a life offense occurred and there is probable cause that the juvenile committed the life

   
        offense.

 there is no probable cause that a life offense occurred or there is no probable cause that the juvenile committed the 

   
        life offense, but some other offense occurred that if committed by an adult would constitute a crime, and there is 
        probable cause to believe the juvenile committed that offense.

 5. The juvenile is bound over to circuit court criminal division to appear on 

Date

 at 

Time

 .

   

 on the charge(s) in the complaint.

   

 on the amended charge(s) of 
 

       

 

   

 on 

Date

 MCL/PACC Code 

 

 at 

Time

 .

 6. This case is transferred to the family division of the circuit court for further proceedings
   

 immediately.

 
 

 
 
 

 

 

 

 

 

7. Bond is set in the amount of $ 

 

 . Type of bond: 

 

   

 Posted

                                                                                                 Judge signature and date

I  certify  that  on  this  date  I  have  transmitted  to  the 
  circuit  court  criminal 
division the prosecutor’s authorization for a warrant application, the complaint, a copy of the register of actions, and any 
recognizances received.

 

CERTIFICATION

                                                                                                Court clerk signature and date

Note: Send a copy of this bindover to the Michigan State Police Criminal Justice Information Center.

 .

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

Bindover/Transfer after Preliminary Examination (9/22) Page 2 of 2