THE PEOPLE OF

 The State of Michigan

 
 

	
TO:
 
 

In the matter of 
 
	 	 	 	 	 ┌	 	 	 	 	

                     
                     

Defendant’s name, address, and telephone no.

CTN/TCN

SID

v

	

 
 

		┐

	

 
 

       
 

  (Name and address of defendant or parent  
   posting bond.)

 

	
 

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 (Name and address of surety or other depositor  
  posting bond.)

 

	

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The defendant/juvenile has violated the conditions of bail as described below:
Offense(s)

   

ORDER
 

Violation(s)

 nonappearance on 

 

Full bail amount
$

Amount of cash deposited
$

TYPE OF BOND:                     
 10% cash             
               

 Personal recognizance
 Cash           

 Surety             

 Real property

   

 other: 

IT IS ORDERED the release is revoked and bond is forfeited. The proceeds of a bond, whether cash, surety, or designated 
real property, shall be disposed of within 45 days of the date of this order. 

 

 *A hearing is scheduled to show good cause why judgment should not enter against the surety for the full amount of the 

  surety bond on 

Date and time

 at 

Location

  before 

Judge

 .

*Use Note: Check this box if the defendant failed to appear and a surety bond was posted.

 

 

                     

Judge signature and date

STATE OF MICHIGANJUDICIAL DISTRICTJUDICIAL CIRCUITORDER REVOKING RELEASE AND FORFEITING BOND, NOTICE OF INTENT TO ENTER JUDGMENTCASE NO. and JUDGEORIMI-Court addressCourt telephone no.Agency Report No.Approved, SCAOForm MC 218, Rev. 9/22MCL 765.15, MCL 765.28, MCL 780.66, MCL 780.67, MCR 3.935(F)(5),MCR 6.103(C), MCR 6.106(I)Page 1 of 2Distribute form to:CourtDefendant/JuvenileSurety or other depositorJIS Code: OFBOrder Revoking Release and Forfeiting Bond, Notice of Intent to Enter Judgment 
Page 2 of 2

(9/22) 

Case No. 
 

TO THE DEFENDANT/PARENT AND JUVENILE:
You  have  28  days  from  the  date  of  this  order  to  surrender  yourself  to  the  court  or  to  satisfy  the  court  that  there  was 
compliance with the conditions of release or that compliance was impossible through no fault of the defendant/juvenile. 
Otherwise, judgment for the full bail amount plus costs will be entered against you. Money or other security on deposit will 
be used toward payment of the judgment.

NOTICE

 A warrant for your arrest/order to apprehend 

 

 has been 

 

 will be 

 

issued.

CERTIFICATE OF MAILING

Use note:  does not need to be completed if the 
document is served through MiFILE. 

I served a copy of this order and notice on the defendant or parent and surety or person who posted bond by first-class 
mail addressed to their last-known addresses as defined by 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.

 

 

                     

                     

              Clerk/Deputy signature and date