Approved, SCAO

STATE OF MICHIGAN

JUDICIAL DISTRICT
JUDICIAL CIRCUIT

AFFIDAVIT AND NOTICE OF ENTRY
OF FOREIGN JUDGMENT

Original - Court
1st copy - Judgment debtor
2nd copy - Judgment creditor
3rd copy - Return

CASE NO.

Court  address

Court  telephone  no.

Judgment creditor's name, address, and telephone no.

Judgment debtor's name, address, and telephone no.

Judgment creditor's attorney, bar no., address, and telephone no.

Judgment debtor's attorney, bar no., address, and telephone no.

v

AFFIDAVIT

I am the judgment creditor of the attached authenticated foreign judgment, which is being filed so that it may be enforced and satisfied
in this state.  The addresses above are the last-known addresses of the judgment creditor and the judgment debtor.

Name  of  state  where  foreign  judgment  was  issued Name of court that issued foreign judgment

Case number

Amount of judgment*

Date of judgment

*The amount of judgment does not include interest.

Subscribed and sworn to before me on

My commission expires:

Notary public,

Judgment creditor/Attorney signature

Date

County and state or other jurisdiction where acting

    .

,

Signature:

County and state or other jurisdiction where commissioned

NOTICE OF ENTRY

The authenticated foreign judgment is accepted for filing.  Enforcement may begin 21 days after the date notice of the filing of the
foreign judgment is mailed.

This document must be sealed
by the seal of the court.

Court clerk

CERTIFICATE OF MAILING

Date

Date

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

MC 62   (3/08)   AFFIDAVIT AND NOTICE OF ENTRY OF FOREIGN JUDGMENT

MCL 691.1171 et seq.

Signature