THE COURT FINDS:

1. A pleading/claim of appeal was filed with the court by the prisoner who is the 

 

 plaintiff. 

 

 defendant. 

2. The prisoner requested suspension of fees and costs in the action because of indigency. A certified statement of the
  prisoner’s trust account was provided showing the current balance and a 12-month history of deposits and withdrawals.

3. On the basis of the certified copy of the prisoner’s trust account, it appears
 
 
 

 a. there are sufficient funds in the account to pay the filing fee, and payment for the full filing fee should be ordered.
 b. there are insufficient funds in the account to pay the filing fee, and payment for a partial fee should be ordered.
 c.  the prisoner is indigent, and payment for the filing fee should be waived/suspended until further order of the court.

4. The prisoner’s average monthly account deposit for the last 12 months is $ 

5. The prisoner’s average monthly account balance for the last 12 months is $ 

 

 

 .

 .

IT IS ORDERED:

 6. The prisoner is ordered to pay a 

 

 full 

 

 partial 

 

filing fee within 21 days from the date of this order. The 

 
 
 
 

 
 
 

 

    prisoner shall resubmit the pleading/claim of appeal for filing along with $ 
 and one copy of this order. If the 
 
    filing fee is not received within 21 days of the date of this order, the court will not file the action and all documents will 
 
    be returned to the prisoner. The prisoner is responsible for making arrangements to have the filing fee paid. The  
    Department of Corrections shall withdraw funds to make monthly payments once the initial fee is paid.

 In addition, the prisoner shall make monthly payments equal to 50% of the deposits made to the prisoner’s trust 

   
        account until the full filing fee is paid. The Department of Corrections shall remove funds from the prisoner’s trust 
        account on a monthly basis until the full filing fee is paid.

 7. Fees and costs in this action are waived/suspended until further order of the court. If the prisoner becomes able to pay 
    fees and costs before conclusion of the litigation, payment of fees and costs will be ordered as required by law.

Approved, SCAO
Form MC 20a, Rev. 5/21
MCL 600.2963, MCR 2.002
Page 1 of 2

Distribute form to: 
Court 
MDOC Court Order Unit
Prisoner
Other party

STATE OF MICHIGANJUDICIAL DISTRICTJUDICIAL CIRCUITCOUNTYORDER REGARDING SUSPENSION OF PRISONER FEES/COSTSCASE NO. and JUDGECourt addressCourt telephone no.Plaintiff’s name, address, and telephone no.vDefendant’s name, address, and telephone no.Plaintiff’s attorney, bar no., address, and telephone no.Defendant’s attorney, bar no., address, and telephone no.Order Regarding Suspension of Prisoner Fees/Costs 
Page 2 of 2

(5/21) 

Case No. 
 

8. If costs are assessed, the court will order payments to be made from the prisoner’s trust account as required by law.

9. If the prisoner fails to pay any fees and costs required by this order, the prisoner shall not commence a new civil action  
  or appeal until the outstanding fees and costs have been paid.

 

                     

Judge signature and date

CERTIFICATE OF MAILING

I served a copy of this order on the prisoner at the institution/facility and on the other party 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.

Date

 

Signature  

 

 

If item 6 is checked, send a copy of this order by first-class mail or e-mail to:

  ATTN: Court Order Unit
  Michigan Department of Corrections
  206 E. Michigan Ave.
  PO Box 30003
  Lansing, MI 48909

  MDOC-CourtOrders@michigan.gov