In the matter of 

First and last name(s), alias(es)

THE COURT FINDS:

1. A restoration order was entered on 

 Date 

 and expires in not less than 14 days. 

2. The qualified restoration provider has recommended that the restoration order be renewed for another 60 days.

3. There is a substantial probability that the juvenile will be competent to proceed within the period of the renewed order.

IT IS ORDERED:

 
 
  of age.

4. The restoration order is renewed for another 60 days starting 

 and is valid for not more

Date

than 120 days from the initial finding of incompetency or until one of the following occurs, whichever is first: 1) the 
juvenile has regained competency, 2) the charges are dismissed by the prosecutor, or 3) the juvenile reaches 18 years 

5. The qualified restoration provider shall submit a report to the court and the qualified juvenile forensic mental health 
  examiner that includes the information required under MCL 712A.18p. The report shall be submitted every 30 days 
  or sooner if and at the time either of the following occurs: 1) the qualified restoration provider determines the juvenile is 
  competent to proceed, or 2) there is no substantial probability the juvenile will be competent to proceed within the period 
  of this order.   

Judge signature and date

Approved, SCAO
Form JC 109, Rev. 1/21
MCL 712A.18s(3)
Page 1 of 1

STATE OF MICHIGANJUDICIAL CIRCUIT - FAMILY DIVISIONCOUNTYEX PARTE RENEWAL OFRESTORATION ORDER(DELINQUENCY PROCEEDINGS)CASE NO.PETITION NO.JUDGECourt addressCourt telephone no.PCS Code: RSOTCS Code: RORI