STATE OF MICHIGAN

JUDICIAL DISTRICT

COMPLAINT AND SUMMONS 
REGARDING DANGEROUS ANIMAL

CASE NO. and JUDGE

Court address

Court telephone no.

In the matter of 

Name of animal 

COMPLAINT

 , am interested in this matter as 
 

1. I, 
 

2. The animal named above is dangerous because
 
 
 
 
 
 
 
 
 
 

    (MCL 287.286a).

    (MCL 287.286a).

 the dog is over 6 months old, was without a license attached to its collar, and ran at large unaccompanied by its owner 

    or engaged in lawful hunting and was not under the reasonable control of its owner after January 10 and before 
    June 15 (MCL 287.286a).

 the dog destroyed property, or habitually caused damage by trespassing on property, of a person not the owner

 the dog attacked or bit a person (MCL 287.286a).
 the dog showed vicious habits or molested a person when that person was lawfully on the public highway 

 the dog ran at large even though licensed and wearing the license tag (MCL 287.286a).
 the animal caused serious injury or death to an individual or a dog (MCL 287.322).

3. Facts in support of the above claim(s) are: Attach separate document if needed.

4. I request a summons be issued commanding 

Name (type or print)

Address                                                                                                                                   City                                        State            Zip

the owner of the animal named above, to appear in court to show cause why the animal should not be destroyed.

  of 

 

 

                     

Complainant address                                                                        City                                               State               Zip                               Telephone no.

Complainant signature

Subscribed and sworn to before me on 
 
 

                     
                     

Date

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

                     

 

 

 

 

 

 

 

 

 

 

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.

 .

 ,

 ,

 . 

 .

Approved, SCAOForm DC 118, Rev. 3/23MCL 287.286a, MCL 287.322Page 1 of 2Distribute form to: Court Owner of animal Complainant ReturnComplaint and Summons Regarding Dangerous Animal 
Page 2 of 2

(3/23) 

Case No. 
 

	
	 	 	 	 	 ┌	 	 	 	 	
TO:                    

SUMMONS

	
 

	

			┐
 

 

			┘

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.

	 	 	 	 	 └	 	 	 	 	
	
IT IS ORDERED:
5. You are ordered to appear before this court on 

Date and Time

  at 
 
 
  hearing may result in a bench warrant being issued for your arrest.

to show cause why the animal identified in the above complaint should not be destroyed. Failure to appear for this 

6. The owner shall immediately turn the animal over to 
 
 
  pursuant  to MCL 287.322. The owner shall notify this authority of the complaint and this order.

to be held at the owner’s expense until the hearing is held and a decision is made for the disposition of the animal 

Date issued
     
 
   
This summons is invalid unless served on or before its expiration date. This document must be sealed by the seal of the court.

Expiration date
(not less than 2 days from hearing date)

 

 
Judge/Magistrate signature and date

 

 

 

 

 

 

  

 

 

 

Complaint and Summons Regarding Dangerous Animal 

(3/23) 

Case No. 
 

PROOF OF SERVICE

TO PROCESS SERVER: You must serve the complaint and summons and file proof of service with the court clerk no 
more than 6 days and no less than 2 days before the hearing date.  If you are unable to complete service, you must return 
this original and all copies to the court clerk.

CERTIFICATE OF SERVICE / NONSERVICE

 I served     

 personally     

 by registered or certified mail, return receipt requested, and delivery restricted to the 

  animal’s owner (copy of return receipt attached)     a copy of the complaint and summons, together with the  
  attachments listed below, on: 

 

 

 I attempted to serve a copy of the complaint and summons, together with the attachments listed below, and have been  

  unable to complete service on:

Name

Date and time of service

Place or address of service

Attachments (if any)

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

 I am a legally competent adult who is not a party or an officer of a corporate party.  I declare under the penalties of 

  perjury that this certificate 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
$

 

 

 

 

 

 

TOTAL FEE
$

  
Signature

  
Name (type or print)

  

I acknowledge that I have received service of a copy of the complaint and summons, together with 

ACKNOWLEDGMENT OF SERVICE

 on 

Date and time

 .

Attachments (if any)

Signature

Name (type or print)

 on behalf of 

  

 

MCL 600.1910, MCR 2.104, MCR 2.105