I REQUEST that the court issue a summons compelling the defendant to appear before the court on these allegations.

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

Date

 

                     

 

Probation officer signature

Probation officer name (type or print)

SUMMONS

THE COURT FINDS probable cause to believe that defendant violated the conditions of probation.

TO DEFENDANT, IN THE NAME OF THE PEOPLE OF THE STATE OF MICHIGAN:

You are ordered to appear in court

at 
 

  
 
 the above address

Date and time

on 

 

Failure to appear at the stated time and place may subject you to arrest. 

 for arraignment on alleged violation(s) of the conditions of probation. 

                     

 
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.

Judge signature and date

Defendant’s name, address, and telephone no.

SID

v

 

CTN

TCN

REQUEST

  Civil        

  Criminal 

Current Charge

THE PEOPLE OF

 The State of Michigan

 

 

  

  

 

   

 I allege that the defendant has committed the following technical probation violation(s):

 I allege that the defendant has committed the following non-technical probation violation(s):

STATE OF MICHIGANJUDICIAL DISTRICTJUDICIAL CIRCUIT REQUEST AND SUMMONS FOR PROBATION VIOLATIONCASE NO. and JUDGEORIMI-Court addressCourt telephone no.Police Report No.Approved, SCAOForm MC 246, Rev. 9/22MCR 6.445Page 1 of 1Distribute form to: Court                                    Probation departmentDefendantProsecutorPROOF OF SERVICE

Case No. 
 

TO PROCESS SERVER:  You must serve the copies of the request and summons regarding probation violation 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 request and summons regarding probation violation and any attachments listed below on: 

 I have attempted to serve the request and summons regarding probation violation, 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

Fee
$

 

 

 

 

                     
Incorrect address fee
$
                     

 

Miles traveled

Fee
$

TOTAL FEE
$

 

 

  
Name (type or print)

  
Title (if applicable)

ACKNOWLEDGMENT OF SERVICE

I acknowledge that I have received service of the request and summons regarding probation violation, together with 

Attachments

Signature

 on behalf of 

 

 , on 

Date and time

 .

CERTIFICATE OF MAILING BY COURT

I certify that on this date I served a copy of the request and summons and 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 signature and date