INFORMATION
FELONY
 AMENDED

                                                             Defendant’s name and address
THE PEOPLE OF THE
STATE OF MICHIGAN 

  v 

Codefendant(s) (if known)

Victim or complainant

Complaining witness

Date: On or about

City/Twp./Village

County in Michigan Defendant TCN

Defendant CTN

Defendant SID

Defendant DOB

Put DOB in Ref. No. row 1 on MC 97

 Put DLN on Ref. No. row 3 on MC 97

Defendant DLN
 

 Oper./Chauf.

 CDL

Police agency report no.

Charge

Maximum penalty

Vehicle Type

Defendant Sex

Defendant Race

 A sample for chemical testing for DNA identification profiling is on file with the Michigan State Police from a previous case.

Witnesses

STATE OF MICHIGAN, COUNTY OF 
 

 .

IN THE NAME OF THE PEOPLE OF THE STATE OF MICHIGAN: The prosecuting attorney for this county appears before 
the court and informs the court that on the date and at the location described, the defendant:

and against the peace and dignity of the State of Michigan.
 

                     

 Prosecuting Attorney

Date

 

 By: 
 

STATE OF MICHIGANJUDICIAL DISTRICTJUDICIAL CIRCUIT JUDGEDISTRICT CASE NO.CIRCUIT CASE NO.Court addressCourt telephone no.District Court ORI: MI-Circuit Court ORI: MI-Approved, SCAOForm MC 200w, Rev. 9/22MCL 764.1 et seq., MCL 766.1 et seq., MCL 767.1 et seq., MCR 6.112(D)Page 1 of 1Distribute form to: CourtProsecutorDefendantCOMPLAINT
FELONY
 AMENDED

                                                             Defendant’s name and address
THE PEOPLE OF THE
STATE OF MICHIGAN 

  v 

Codefendant(s) (if known)

Victim or complainant

Complaining witness

Date: On or about

City/Twp./Village

County in Michigan Defendant TCN

Defendant CTN

Defendant SID

Defendant DOB

Put DOB in Ref. No. row 1 on MC 97

 Put DLN on Ref. No. row 3 on MC 97

Defendant DLN
 

 Oper./Chauf.

 CDL

Police agency report no.

Charge

Maximum penalty

Vehicle Type

Defendant Sex

Defendant Race

 A sample for chemical testing for DNA identification profiling is on file with the Michigan State Police from a previous case.

Witnesses

STATE OF MICHIGAN, COUNTY OF 
 

 .

The complaining witness says that on the date and at the location described, the defendant, contrary to law,

 The complaining witness asks that defendant be apprehended and dealt with according to law.

Warrant authorized on 

Date

 by:

I  declare  under  the  penalties  of  perjury  that  this  complaint  has  been 
examined  by  me  and  that  its  contents  are  true  to  the  best  of  my 
information, knowledge, and belief.

Prosecuting official

  

 

 

 

 

 

 

 

 

 

 

 Security for costs posted

Date

Complaining witness signature

 
 
 

                     
   
                     

 

 

 

 

 

 

 

  

 

STATE OF MICHIGANJUDICIAL DISTRICTJUDICIAL CIRCUIT JUDGEDISTRICT CASE NO.CIRCUIT CASE NO.Court addressCourt telephone no.District Court ORI: MI-Circuit Court ORI: MI-Approved, SCAOForm MC 200w, Rev. 9/22MCL 764.1 et seq., MCL 766.1 et seq., MCL 767.1 et seq., MCR 6.101MCR 6.102Page 1 of 1Distribute form to: CourtProsecutorDefendantWARRANT
FELONY

                                                             Defendant’s name and address
THE PEOPLE OF THE
STATE OF MICHIGAN 

  v 

Codefendant(s) (if known)

Victim or complainant

Complaining witness

Date: On or about

City/Twp./Village

County in Michigan Defendant TCN

Defendant CTN

Defendant SID

Defendant DOB

Defendant DLN
 

 

 Oper./Chauf.

 CDL

Police agency report no.

Charge

Maximum penalty

Vehicle Type

Defendant Sex

Defendant Race

 A sample for chemical testing for DNA identification profiling is on file with the Michigan State Police from a previous case.

Witnesses

STATE OF MICHIGAN, COUNTY OF 
 
To any peace officer or court officer authorized to make arrest: The complaining witness has filed a sworn complaint in
this court stating that on the date and the location described, the defendant, contrary to law,

 .

 the complaint is for an assaultive crime or an offense involving domestic violence, as defined in MCL 764.1a.
 there is reason to believe from the complaint that the person against whom the complaint is made will not appear on

THE  COURT  FINDS  probable  cause  to  believe  defendant  committed  the  offense(s)  set  forth  and  that  the  following 
circumstance(s) apply: 
 
 
 
 
THEREFORE, IN THE NAME OF THE PEOPLE OF THE STATE OF MICHIGAN,

 the issuance of a summons poses a risk to public safety. 

 the prosecutor has requested an arrest warrant.

    a summons.

 

 a. I order you to arrest and bring defendant before the 
 

 b. I order you to bring defendant before the 

  

 District Court immediately.

 District Court.

                     

 
See return on next page. 

Judge/Magistrate signature and date

 

  

 

 

 

 

 

 

STATE OF MICHIGANJUDICIAL DISTRICTJUDICIAL CIRCUIT JUDGEDISTRICT CASE NO.CIRCUIT CASE NO.Court addressCourt telephone no.District Court ORI: MI-Circuit Court ORI: MI-Approved, SCAOForm MC 200w, Rev. 9/22MCL 764.1 et seq., MCL 766.1 et seq., MCL 767.1 et seq., MCR 6.102Page 1 of 2Distribute form to: CourtProsecutorDefendant 

   

RETURN

Date

 .

Case No. 
 

 at 

Time

 

Peace officer

As ordered in this warrant, the defendant was arrested on 

Place of arrest

t 

  a

Date
 

   

Warrant Return (9/22) Page 2 of 2BINDOVER/TRANSFER AFTER
PRELIMINARY EXAMINATION
FELONY

                                                             Defendant’s name and address
THE PEOPLE OF THE
STATE OF MICHIGAN 

  v 

Codefendant(s) (if known)

Victim or complainant

Complaining witness

Date: On or about

City/Twp./Village

County in Michigan Defendant TCN

Defendant CTN

Defendant SID

Defendant DOB

Put DOB in Ref. No. row 1 on MC 97

 Put DLN on Ref. No. row 3 on MC 97

Defendant DLN
 

 Oper./Chauf.

 CDL

Police agency report no.

Charge

Maximum penalty

Vehicle Type

Defendant Sex

Defendant Race

 A sample for chemical testing for DNA identification profiling is on file with the Michigan State Police from a previous case.

Date: 
  

                          District judge: 

Reporter/Recorder                                                                          Cert. no.

 
Represented by counsel                                                             Bar no.

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

EXAMINATION WAIVER

1.  I, the defendant, understand:
  a.  I have a right to employ an attorney.
  b.  I may request an appointed attorney if I am financially unable to employ one.
 
 
2.  I voluntarily waive my right to a preliminary examination and understand that I will be bound over to circuit court on the 
 

c.  I have a right to a preliminary examination where it must be shown that a crime was committed and probable cause exists
    to charge me with the crime.

charges in the complaint and warrant (or as amended).

Defendant attorney                                                                           Bar no.

Defendant

 

I consent to this waiver: 

Prosecuting attorney                                                                                         Bar no.

 3.  Examination was waived on 

 4.  Examination was held on 

Date

Date

    both that an offense not cognizable by the district court has been committed and that the defendant committed the offense.

 and it was found that probable cause exists to believe

ADULT BINDOVER

 .

 at 

Time

    

 Posted

 .

 .

 5.  The defendant is bound over to circuit court to appear on 

Date

   

 on the charge(s) in the complaint.

 on the amended charge(s) of

.  Bond is set in the amount of $ 

 . Type of bond: 

 

 MCL/PACC Code 
 

 

 

   
 

 
 
              
 

  6

 

 

 

                                                                                          Judge signature and date

STATE OF MICHIGANJUDICIAL DISTRICTJUDICIAL CIRCUIT JUDGEDISTRICT CASE NO.CIRCUIT CASE NO.Court addressCourt telephone no.District Court ORI: MI-Circuit Court ORI: MI-Approved, SCAOForm MC 200w, Rev. 9/22MCL 766.14(2), MCR 6.110, MCR 6.911 Page 1 of 2Distribute form to: CourtProsecutorDefendantCase No. 
 

 3. Examination was waived on 

 .

JUVENILE BINDOVER/TRANSFER

 4. Examination was held on 

 and it was found that

Date

Date

 there is probable cause that a life offense occurred and there is probable cause that the juvenile committed the life

   
        offense.

 there is no probable cause that a life offense occurred or there is no probable cause that the juvenile committed the 

   
        life offense, but some other offense occurred that if committed by an adult would constitute a crime, and there is 
        probable cause to believe the juvenile committed that offense.

 5. The juvenile is bound over to circuit court criminal division to appear on 

Date

 at 

Time

 .

   

 on the charge(s) in the complaint.

   

 on the amended charge(s) of 
 

       

 

   

 on 

Date

 6. This case is transferred to the family division of the circuit court for further proceedings
   

 immediately.

 MCL/PACC Code 

 

 .

7. Bond is set in the amount of $ 

 

 . Type of bond: 

 

   

 Posted

 at 

Time

 .

 
 

 
 
 

 

 

 

 

 

 

                                                                                             Judge signature and date

I  certify  that  on  this  date  I  have  transmitted  to  the 
  circuit  court  criminal 
division the prosecutor’s authorization for a warrant application, the complaint, a copy of the register of actions, and any 
recognizances received.

 

CERTIFICATION

                                                                                                 Court clerk signature and date

Note: Send a copy of this bindover to the Michigan State Police Criminal Justice Information Center.

Bindover/Transfer after Preliminary Examination (9/22) Page 2 of 2