Approved, SCAO

STATE OF MICHIGAN

Court  address

Plaintiff's  name(s)

JUDICIAL DISTRICT
JUDICIAL CIRCUIT

PAYMENT RECEIPT AND
INVENTORY OF SEIZED PROPERTY

Defendant's  name(s)

v

Original - Court
1st copy - Defendant

2nd copy - Officer
3rd copy - Plaintiff

CASE NO.

Court  telephone  no.

TO THE OFFICER SEIZING PROPERTY:  This form must be filed with the court within 7 days of the payment of funds or seizure
of property.

RECEIPT  FOR  PAYMENT OF FUNDS

1. I collected $

on

Date

from

2. Payment was made by

cash.

check no.

  .

money order/cashier's check no.

    .

    .

3. a. Balance due .......................................................................................................
b. Minus payment ...................................................................................................
c. Statutory service and mileage fees ....................................................................................................
d. Statutory percentage of line b fees : 7% of                   / 3% of                . ........................................
e. Statutory expenses ............................................................................................................................
f. Plus total of lines c, d, and e above ....................................................................
g. New balance due* ............................................................................................

$
$

$
$

$
$
$

*Additional statutory interest, fees (7% of first $8,000.00 and 3% of remaining balance), and expenses may be charged in addition to the
unpaid balance.

Attach  additional  sheets  if  necessary.

INVENTORY OF PROPERTY SEIZED

Quantity

Item/Description/Model

Type/V.I.N./Serial Number

Real property seized (copy attached)

    .

Property may be redeemed by payment in full of the judgment and all statutory fees and statutory expenses.   If the property is not
redeemed, it will be sold at public sale and the proceeds applied to the judgment according to law.  For further information call the
individual named below.

I certify that I am authorized to seize property under MCR 3.106 and that the above statements are true and accurate.

Date

Signature

MC 82   (4/14)   PAYMENT RECEIPT AND INVENTORY OF SEIZED PROPERTY

MCR 3.106

Name  (type  or  print)    (Court  officer/Deputy  sheriff)

Telephone no.