STATE OF MICHIGAN

PRETRIAL RELEASE ORDER

CASE NO.

JUDICIAL DISTRICT
JUDICIAL CIRCUIT

 
 
Court address

 
 

 AMENDED CONDITIONS
 AMENDED LEIN EXPIRATION DATE

JUDGE

DISTRICT CASE NO.

Court telephone no.

Defendant’s name, address, and telephone no.

 

v

CTN/TCN

SID

DOB

ORI
MI-

 
 

THE PEOPLE OF

 The State of Michigan

 In the matter of 
  

 

 
 

1. 
 

 a. Release on personal recognizance shall be ordered as required by MCR 6.106(C). 
 appearance. 
 b. Release on personal recognizance will not reasonably ensure 

 

 

 public safety.

 
 

 2. Under 18 USC 922(g)(8), the court found, at a hearing, that the defendant/juvenile represents a credible threat to  
    the physical safety of one or more persons as defined in 18 USC 922(g)(8) and 18 USC 921(a)(32) and named in 
    item 5q. **Needed for NCIC.
 3. This case is bound over from district court.

 a. The defendant/juvenile shall post a new bond and comply with the terms and conditions in item 5.
 b. The bond previously ordered is continued, and the defendant/juvenile shall comply with the terms and conditions 

5. The defendant/juvenile shall comply with the following terms and conditions that are checked:

 a. Personally appear for any examination, arraignment, trial, sentencing, or at any time and place as directed by  

        this court. If represented by an attorney in this case, any notice to appear may be given to the defendant’s  
        attorney instead of the defendant.

 b. Abide by any judgment entered in this case and surrender to serve any sentence imposed.

See additional page for more conditions.)

IT IS ORDERED:
4. 
 
 

        in item 5.

 
 
 

   

  (

Date of arrest

Type of offense

Arresting agency

Agency file no.

Offense(s) 

Statute/ordinance citation(s)

 Misdemeanor 

 Felony

Purpose of next appearance

Time of appearance

Date of appearance

Place of appearance

 At the court address above 

 

 Other:

TYPE OF BOND:    
  Cash/Surety   
  *Proof of value and interest in real property is required.

  Personal recognizance
  Cash/Surety/10% Cash 

  Real property*

$

Full bail amount

Bond set by Judge/Magistrate

Approved, SCAOForm MC 240, Rev. 9/22MCL 765.6b, MCR 3.935, MCR 6.103, MCR 6.106, MCR 6.610, 18 USC 922(g)(8)Page 1 of 4Distribute form to:CourtDefendantProsecutorSheriff/FacilityOriginating law enforcement agency (when applicable)LEIN (when applicable)Pretrial Release Order 
Page 2 of 4

(9/22) 

IT IS ORDERED (continued):

Case No. 
 

 c.  Do not leave the State of Michigan without the permission of this court.

 d. Do not commit any crime while released.

 e. Immediately notify this court, in writing, of any change of address or telephone number. 

 f.  Make reports to a court agency as specified by this court or the agency.

 g.  Do not use 

 alcohol. 

 marijuana. 

 illegal controlled substances.

 h. Participate in a substance abuse testing or monitoring program.

 i.   Participate in a specified treatment program for any physical or mental condition, including substance abuse.

 j.   Comply with restrictions on personal association, place of residence, place of employment, or travel.

 k.  Surrender driver’s license or passport.

 l.   Continue to seek employment.

 m. Comply with the following curfew: 

 

 n. Continue or begin an educational program.

 o. Remain in the custody of a responsible member of the community. The community member agrees to monitor the  

        defendant/juvenile and report any violation of these release conditions to the court.

 p. Do not possess or purchase a firearm or other dangerous weapon.

 q. Do not harass, intimidate, beat, molest, wound, stalk, threaten, or engage in other conduct that would place any    
 
 

        of the following persons or a child of any of the following persons in reasonable fear of bodily injury: spouse,  
        former spouse, individual with whom the defendant has a child in common, resident or former resident of the  
        defendant’s household. 

 r.   Do not assault, harass, intimidate, beat, molest, wound, or threaten the following person(s):

       
       

Name(s)

       

Name(s)

       

Address or other location

 u. Other:

 s.  Do not have (or cause any third party to have) any direct or indirect contact with the following person(s):

        (Note: This condition also applies while the defendant/juvenile is in custody.)

 t.   Do not enter the following specified premises or areas: 

       

 May go to the address once, accompanied by a peace officer, to remove personal belongings.

 

   

 

 

 

 

 

 

 

   

   

 

   

 

 

 
 
 
 

   

 
 

 
 

 

 

 

 

 

Pretrial Release Order 
Page 3 of 4

(9/22) 

Case No. 
 

 6. The 

 

 sheriff 

 

 
Custodial agency/Facility

 

 
 
 
 
 

    shall hold the defendant/juvenile named above in its care and custody until bond is posted and the terms and  
 
    conditions  specified in item 5 are acknowledged. The defendant/juvenile shall be brought to all court appearances    
    while in custody or as otherwise ordered. The sheriff or director or designee of the custodial facility is authorized to    
    obtain and consent to routine, nonsurgical medical and dental care for the juvenile and emergency medical, dental,   
    and surgical treatment of the juvenile. 

 

 7. This order shall be entered into LEIN, is effective when signed, and expires on  
    (Note: Check when release is subject to conditions necessary to protect 1 or more named persons under MCL 765.6b or for NCIC.)
 
 
Height

Driver’s license number

Date of birth*

Weight

Race*

Sex*

 

 .

Hair color Eye color

Other identifying information

*These items must be filled in for the police/sheriff to enter on LEIN; the other items are not required but are helpful.

 

                     

Judge/Magistrate signature and date

 

                     

Pretrial Release Order 
Page 4 of 4

(9/22) 

Case No. 
 

ACKNOWLEDGMENT OF PRETRIAL RELEASE CONDITIONS

I  acknowledge  and  understand  the  terms  and  conditions  of  my  release  from  jail.  If  I  fail  to  perform  all  the  terms  and 
conditions,  I  may  be  subject  to  arrest  without  a  warrant,  jail,  contempt  of  court,  and  new  conditions  of  release.  If  my 
release is revoked and a bond was posted, the full amount of my bond, regardless of who posted it, may be forfeited. If I 
am arrested for a violation of these terms and conditions in another state, I waive all extradition proceedings and will be 
immediately returned to this state.

NOTICE OF FIREARMS RESTRICTION: If item 5q is a condition of my release, federal and/or state law may prohibit me 
from possessing or purchasing ammunition or a firearm (including a rifle, pistol, or revolver).

                                                      

Defendant/Juvenile’s signature

Date

Date

Bond deposited by Defendant: If all the terms and conditions of pretrial release are met, the money deposited (bond) will 
be used to pay any fine, state minimum costs, restitution, statutory assessments, and other costs imposed. Any balance 
will be returned to me as authorized by statute and court rule.

                                                       

Defendant’s signature

 

 Third Party: 

I understand and agree that if the defendant fails to appear,
Bond deposited by 
the money deposited (bond) may be forfeited and a judgment entered for the entire amount of the bond. If the defendant 
appears as directed, the full amount of the bond will be returned to me unless I deposited a 10% cash bond. In that instance,
the court will return only 90% of the bond to me. 
 If I am entitled to return of any bond, I agree that it may be applied to 
any of the defendant’s fines/costs/assessments upon conviction. 

 Surety/Agent: 

 

                                                       

Date
 
 
 
 

                     
                                                                                          
                     
                     

 

                     

Signature of depositor/surety/agent and identification (i.e. DLN)
 

 

 

 

 

 

 

 

Name of depositor/surety/agent (type or print)

 

Address                                                                                 

City, state, zip                        

 

 

 

Telephone no.

                        
Use Note: If a third party or surety posted bond for the defendant, the court clerk may provide the third party or surety 
with a copy of the terms and conditions of release.