Distribution:
Original - Governor
1st copy - Court
2nd  copy  -  Prosecutor

WAIVER OF EXTRADITION

3rd  copy  -  Sheriff/DOC
4th copy - Defendant (Fugitive)
5th copy - Agent of demanding state

CASE NO.

Court  telephone  no.

The State of Michigan

Defendant (Fugitive) name, address, and telephone no.

Approved,  SCAO

STATE OF MICHIGAN

JUDICIAL DISTRICT
JUDICIAL CIRCUIT

Court  address

THE PEOPLE OF

  DLN

DOB

v

WAIVER

I,

Name

County,

State

,  am the person wanted by

on a pending arrest warrant charging the crime of

I waive the issuance and service of a Michigan Governor's Warrant and all other procedures incidental to extradition proceedings,

including the right to an attorney unless I have already retained one.  I voluntarily return to the demanding state in the custody of

   .

the agent of that state.

Date

Signature

CERTIFICATION BY JUDGE

The defendant named above personally appeared before me on this date and was advised of his/her legal rights as provided by law.

The defendant freely and voluntarily executed this waiver of extradition in my presence.

The

sheriff of
Michigan Department of Corrections

County, Michigan

shall hold the defendant in custody without bail and

 shall deliver the defendant to the agents of

State

.

Date

Judge

Bar no.

This waiver must be sealed with the seal of the court.

Send  Governor's copy to:

Governor's Office
Attention:  Extradition Officer
Legal  Division
Olds Plaza
111 S. Capitol
Lansing,  Michigan  48933

MC 271   (3/09)   WAIVER OF EXTRADITION

MCL 780.25