Here is the text we could read:
Plaintiff’s name, address, and telephone no.
Plaintiff’s attorney, bar no., address, and telephone no.
v
Defendant’s name, address, and telephone no.
If you require accommodations to use the court
because of a disability or if you require a foreign language
interpreter to help you fully participate in court proceedings,
please contact the court immediately to make arrangements.
Rental unit eviction
Land contract forfeiture
NOTICE TO THE DEFENDANT: In the name of the people of the State of Michigan you are notified:
1. The plaintiff has filed a complaint against you and wants
to recover possession, after land contract forfeiture, of
a money judgment for
to evict you from
Address or description of premises
2. You are summoned to be in the district court on
Day, date, and time
at the court address above,
at
Location
, courtroom
.
is
is not brought in the county or district in which the premises or any part of the premises is situated.
3. This action
4. You have the right to have the case tried in the proper county, district, or court. The case will be transferred to the proper
county, district, or court if you file a motion with the court for such transfer.
5. You have the right to a jury trial. If you do not demand a jury trial and pay the required jury fee in your first defense
6. If you are in district court on time, you will have an opportunity to give the reasons why you feel you should not be evicted.
Bring witnesses, receipts, and other necessary papers with you.
7. If you are not in district court on time, you may be evicted without a trial and a money judgment may be entered against you.
response, you will lose this right.
This document must be sealed by the seal of the court.
CERTIFICATE OF MAILING BY COURT*
Court clerk signature and date
I certify that on this date I served a copy of this summons and the complaint and required attachments on the
defendant(s) by first-class mail addressed to their last-known addresses as defined in MCR 2.107(C)(3).
CERTIFICATE OF MAILING BY PLAINTIFF*
Court clerk signature and date
I served a copy of this summons and the complaint and required attachments on the defendant(s) by first-class mail
addressed to their last-known addresses as defined in MCR 2.107(C)(3). I declare under the penalties of perjury that this
certificate of mailing has been examined by me and that its contents are true to the best of my information, knowledge
and belief. I have attached a receipt of mailing from the post office.
*The certificate of mailing applies to landlord-tenant cases only.
Plaintiff signature and date
Approved, SCAO
Form DC 104, Rev. 3/23
MCL 600.5735, MCR 2.102, MCR 4.201(C), MCR 4.202(E)
Page 1 of 2
Distribute form to:
Court
Tenant
Mailing
Landlord/Landlady
Proof of service
STATE OF MICHIGANJUDICIAL DISTRICTCOUNTYSUMMONSLandlord-Tenant/Land ContractCASE NO. and JUDGECourt address Court telephone no. (Tenant’s Copy)
Plaintiff’s name, address, and telephone no.
Plaintiff’s attorney, bar no., address, and telephone no.
v
Defendant’s name, address, and telephone no.
Rental unit eviction
Land contract forfeiture
NOTICE TO THE DEFENDANT: In the name of the people of the State of Michigan you are notified:
1. The plaintiff has filed a complaint against you and wants
to recover possession, after land contract forfeiture, of
a money judgment for
to evict you from
Address or description of premises
2. You are summoned to be in the district court on
Day, date, and time
at the court address above,
at
Location
, courtroom
.
is
is not brought in the county or district in which the premises or any part of the premises is situated.
3. This action
4. You have the right to have the case tried in the proper county, district, or court. The case will be transferred to the proper
county, district, or court if you file a motion with the court for such transfer.
5. You have the right to a jury trial. If you do not demand a jury trial and pay the required jury fee in your first defense
6. If you are in district court on time, you will have an opportunity to give the reasons why you feel you should not be evicted.
Bring witnesses, receipts, and other necessary papers with you.
7. If you are not in district court on time, you may be evicted without a trial and a money judgment may be entered against you.
response, you will lose this right.
This document must be sealed by the seal of the court.
Court clerk signature and date
could owe your landlord money. It is important to respond to this quickly.
HOW TO GET HELP
• You have received an important legal document from a court. Your landlord is trying to evict you. This means you could lose your housing and you
• You may hire an attorney to help you answer the complaint and prepare defenses. If you cannot afford an attorney, you can get help at
michiganlegalhelp.org or you might qualify for assistance through a local legal aid office. If you do not have Internet access at home, you can
•
•
access the Internet at your local library.
If you do not have an attorney, but have money to hire one, you can find an attorney through the State Bar of Michigan Lawyer Referral Service at
1-800-968-0738 or a local lawyer referral service at michbar.org.
If you require accommodations to use the court because of a disability or if you require a foreign language interpreter to help you fully
participate in court proceedings, please contact the court immediately to make arrangements.
Approved, SCAO
Form DC 104, Rev. 3/23
MCL 600.5735, MCR 2.102, MCR 4.201(C), MCR 4.202(E)
Page 2 of 2
Distribute form to:
Court
Tenant
Mailing
Landlord/Landlady
Proof of service
STATE OF MICHIGANJUDICIAL DISTRICTCOUNTYSUMMONSLandlord-Tenant/Land ContractCASE NO. and JUDGECourt address Court telephone no. Summons, Landlord-Tenant/Land Contract
(3/23)
Case No.
PROOF OF SERVICE
TO PROCESS SERVER: You must serve the summons and complaint and file proof of service with the court clerk. If you
are unable to complete service, you must return this original and all copies to the court clerk.
CERTIFICATE OF SERVICE / NONSERVICE
I served
personally
by registered or certified mail, return receipt requested, and delivery restricted to the
(who was of suitable age, informed of the contents, and asked to deliver the documents promptly to the defendant(s))
after diligent attempts at personal service, by securely attaching the papers to the main entrance of the tenant’s
addressee (copy of return receipt attached)
or tenants’ dwelling unit as described below a copy of the summons and complaint, together with the
attachments listed below, on:
by delivery to a member of the defendant’s or defendants’ household
I have attempted to serve a copy of the summons and complaint, together with the attachments listed below, and have
been unable to complete service on:
Name
Date and time of service
Place or address of service
Attachments (if any)
Attempts at service by secure attachment
I am a sheriff, deputy sheriff, bailiff, appointed court officer or attorney for a party.
I am a legally competent adult who is not a party or an officer of a corporate party. I declare under the penalties of
information, knowledge, and belief.
perjury that this certificate of service has been examined by me and that its contents are true to the best of my
Service fee
$
Incorrect address fee
$
Name (type or print)
TOTAL FEE
$
Miles traveled
Miles traveled
Signature
Fee
$
Fee
$
I acknowledge that I have received service of a copy of the summons and complaint, together with
ACKNOWLEDGMENT OF SERVICE
.
on
Date and time
on behalf of
Attachments (if any)
Signature
Name (type or print)
MCR 2.104, MCR 2.105, MCR 4.201(D), MCR 4.202(F) 
