THE PEOPLE OF

 The State of Michigan

 
 

Defendant’s name, address, and telephone no.

v

1. The defendant was convicted on 

Date

 for

 violating section 625(1), (3), (7), or (8) of the Michigan vehicle code or a substantially corresponding local ordinance.

 violating section 625(4) or (5) of the Michigan vehicle code.

 violating section 626(3) or (4) of the Michigan vehicle code.

 driving in violation of a suspension/revocation with at least two or more prior violations of a suspension or revocation.

2. The violation occurred while the defendant was driving a vehicle identified as:

  Year: 
 

 Make: 
 

 License plate no.: 

 

 VIN: 
 

IT IS ORDERED:

3. The defendant shall have:

ORDER

 a. himself/herself and the vehicle immobilized through tether technology.

 b. the above described vehicle immobilized by use of any available means that locks the ignition, wheels, or steering

        of the vehicle or otherwise prevents the defendant from operating the vehicle.

4. Unless otherwise ordered, sale of the vehicle to a non-family member, with proof of sale to the court, satisfies the
 

immobilization requirement.

5. This order shall be satisfied at the expense and risk of the owner, co-owner, lessee, or co-lessee for 

days

  starting 

Date

 unless otherwise ordered by the court.

If the vehicle is not immobilized by the above start date, the vehicle is subject to impoundment by any law enforcement 

 
  officer in the state until further order of the court.

Approved, SCAO
Form MC 267, Rev. 9/20
MCL 257.904d, MCL 257.904e
Page 1 of 2

Distribute form to:
Court
Defendant
Return

STATE OF MICHIGANJUDICIAL DISTRICTJUDICIAL CIRCUIT ORDER FOR VEHICLE IMMOBILIZATIONCASE NO. and JUDGECourt addressCourt telephone no.Order for Vehicle Immobilization 
Page 2 of 2

(9/20) 

Case No. 
 

 6. Other:

 

                     

Judge/Magistrate signature and date

NOTE: It is a 93 day misdemeanor to tamper with, remove, or bypass a device that has been installed on a vehicle by 
court order for vehicle immobilization or to purchase, lease, or otherwise obtain a motor vehicle during a period of vehicle 
immobilization.

I certify that on 

Date

 , I immobilized the above described vehicle by use of the following means:

CERTIFICATION OF IMMOBILIZATION

Date

Signature

 

Name (type or print)

City, state, zip

Business name                                                                          Telephone no.