THE PEOPLE OF                                     Defendant’s name and address

  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

Vehicle Type

Defendant Sex

Defendant Race

Police agency report no.

Charge

Maximum penalty

 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 DISTRICTCOMPLAINTMISDEMEANORCASE NO. and JUDGEORICourt addressCourt telephone no.MI-Approved, SCAOForm DC 225s, Rev. 9/22MCL 764.1, MCL 764.1a, MCR 6.101, MCR 6.102, MCR 6.615 Page 1 of 1Distribute form to: CourtProsecutorDefendant THE PEOPLE OF                                     Defendant’s name and address

  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

Vehicle Type

Defendant Sex

Defendant Race

Police agency report no.

Charge

Maximum penalty

 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 

 THE STATE OF MICHIGAN 

TAKE NOTICE:  YOU ARE SUMMONED TO APPEAR for arraignment on 

 
 

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.

 , Michigan,  

 
Location

 

 

Judge/Magistrate signature and date

STATE OF MICHIGANJUDICIAL DISTRICTSUMMONSMISDEMEANORCASE NO. and JUDGEORICourt addressCourt telephone no.MI-Approved, SCAOForm DC 225s, Rev. 9/22MCL 764.1, MCL 764.1a, MCL 764.3, MCR 6.102, MCR 6.103, MCR 6.615Page 1 of 1Distribute form to: CourtProsecutorDefendantCase No. 
 

PROOF OF SERVICE

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 name/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)

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