Approved, SCAO

STATE OF MICHIGAN

JUDICIAL CIRCUIT
COUNTY

Court  address

B

Petitioner name

Original - Court
1st copy - Judge/Assignment clerk (green)
2nd copy - Respondent (blue)

3rd copy - Petitioner (pink)
4th copy - Return (yellow)

MOTION AND ORDER TO DISMISS ACTION
FOR PERSONAL PROTECTION ORDER

A

CASE NO.

Court  telephone  no.

Respondent name, address, and telephone no.

Address and telephone no. where court can reach petitioner

v

1. On

Date

I filed a petition for a personal protection order.

2. I ask the court to dismiss the action without prejudice because:
Explain why you want to dismiss your petition for personal protection order.

MOTION

3. No order for personal protection has been entered.

4. The respondent has not been served with a copy of the petition for personal protection order.

Petitioner's signature

ORDER

CERTIFICATE OF MAILING

Petitioner's signature

CERTIFICATE OF NONSERVICE

Petitioner's signature

IT IS ORDERED that the petition for personal protection order is dismissed without prejudice.

Judge

Bar no.

I certify that on this date I served a copy of this motion and order on the parties or their attorneys by first-class mail
addressed to their last-known addresses as defined by MCR 2.107(C)(3).

I certify that respondent was not served a copy of the petition for personal protection order and therefore I did not serve a copy
of this motion and order on the respondent.

CC 378   (3/09)   MOTION AND ORDER TO DISMISS ACTION FOR PERSONAL PROTECTION ORDER

MCL 600.2950, MCL 600.2950a, MCR 3.704

C D

E

F

Date

Date

G

Date

H

Date

Form CC 378

MOTION AND ORDER TO DISMISS ACTION FOR
PERSONAL PROTECTION ORDER

Use this form if you do not want to continue with your petition for a personal protection order and the order
has not been signed yet.

INSTRUCTIONS  FOR  COMPLETING  "MOTION  TO  DISMISS  ACTION  FOR  PERSONAL  PROTECTION
ORDER"

Please print neatly.  Press firmly because you are printing on five copies.

If you do not want to continue with your petition for a personal protection order and a personal protection order has not
been signed by the judge yet, you can ask the court to dismiss your petition by filling out this form.  Please follow the
directions carefully.

Items A through F must be completed before your motion can be filed with the court.  Please read the instruction for each
item.  Then fill in the correct information for that item on the form.

Fill in the "Case No." the same way you did on form CC 375 or form CC 377.

Fill in "petitioner" and "respondent" names and addresses in the same way you did on form CC 375 or Form
CC 377.

Write in the same date you put in   I    on form CC 375 or   H   on form CC 377.

Explain why you no longer want the court to enter a personal protection order.

If you did not serve the respondent with a copy of the petition for personal protection order yet, check this box.

Write in today's date and sign the form.  Hand the form to the county clerk.  The clerk will forward the order to
the judge.  Check back with the clerk to see if the order has been signed.  If so, return to the clerk.  The clerk
will keep two copies and return the blue, pink, and yellow copies to you.  Then complete either  G  or   H   .

Complete either    G    or    H    .

If you already served the respondent with a copy of the petition, you must serve the respondent with a copy
of this form.  Place the blue copy of this form in an envelope.  Then go to the post office, ask the post office to mail it
for you, and ask for a postal receipt.  Then follow the instructions for   G   below.

Write in the date that's on the postal receipt on both the pink and yellow copies and sign both copies.  Attach
the postal receipt to the yellow copy and return the yellow copy to the county clerk.  You can either mail or take
the yellow copy to the county clerk.  Keep the pink copy for your records.

If you did not already serve the respondent with a copy of the petition, do not serve the respondent with
a copy of this form.  Follow the instructions for    H    below.

Write in today's date and sign the form on both the pink and yellow copies.  Hand the yellow copy to the county
clerk.  You may throw the blue copy away.  Keep the pink copy for your records.

A

B

C

D

E

F

G

H