You are notified that the petitioner has requested a personal protection order be issued against you. A hearing 
  has been scheduled to decide whether to issue the personal protection order.

C

  Judge:   

  Date:     

  Time:     

 

 

 

  Location: 
 

 
 

 

D
 

Date

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.

If you do not attend this hearing, a personal protection order can still be entered against you.

 

 
Signature

  TO THE PETITIONER:

  The respondent must be served with this notice at least one day before the hearing date if you are asking for a 
  domestic relationship PPO (CC 375 or CC 375m) or a nondomestic stalking PPO (CC 377 or CC 377m). If you filed a 
  petition for a nondomestic sexual assault PPO (CC 395 or CC 395m), the respondent must be served with this notice 
  at least two days before the hearing.

 

If the respondent is under 18 years of age, you must also serve the parents, guardians, or custodians of the respondent.

STATE OF MICHIGANJUDICIAL CIRCUITCOUNTYNOTICE OF HEARING ON PETITION FOR PERSONAL PROTECTION ORDERCASE NO. and JUDGECourt address                     Court telephone no.     Approved, SCAOForm CC 381, Rev. 6/22MCR 3.705(A)(5), (B)Page 1 of 1Distribute form to: Court Judge/Assignment clerk Respondent PetitionerReturnPetitioner namevRespondent name TO:ABNotice of Hearing on Petition for Personal Protection Order 

(6/22) 

Case No. 
 

PROOF OF SERVICE
TO PROCESS SERVER:  You must serve the notice of hearing for a personal protection order 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 / AFFIDAVIT OF SERVICE / NONSERVICE

 I am a sheriff, deputy sheriff, bailiff, appointed court officer or attorney

 I am a legally competent adult who is not a party or an officer of a

     for a party (MCR 2.104[A][2]).  (notarization not required)  

     corporate party. (notarization required)

 I served     

 by registered mail or certified mail (copy of return receipt attached)
  a copy of the notice of hearing on the petition for personal protection order and any attachments on:

 personally 

 

 I have personally attempted to serve the notice of hearing for a personal protection order and any attachment. I have 

  been unable to complete service on:
Name of respondent

Complete address of service

Day, date, time

Name of parent/guardian/custodian

Complete address of service

Day, date, time

Name of parent/guardian/custodian

Complete address of service

Day, date, time

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
$
 

                     
Incorrect address fee
$

                     

 

Miles traveled

Miles traveled

Fee
$

Fee
$

Subscribed and sworn to before me on 
 
 

                     
                     

Date

My commission expires on 
 
Notary public, State of Michigan, County of 

                     

 

 

 

  
Signature

  
Name (type or print)

  
Title (if applicable)

TOTAL FEE
$

 

 

 

 

 

 

Deputy clerk/Notary public signature

 . 

Name (type or print)
 

 

 . 

 Acting in the County of 

 

 

 

 

 

 

 

 . 
 

 .

 This notarial act was performed using an electronic notarization system or a remote electronic notarization platform.

I acknowledge that I have received service of the notice of hearing for a personal protection order, together with 

ACKNOWLEDGMENT OF SERVICE

Attachments

Signature of respondent

 

 

Signature of respondent’s parent/guardian/custodian

Signature of respondent’s parent/guardian/custodian

 , on 

Date and time

 .

MCR 2.105(A)