1. You are notified that a certain land contract, dated 

 

 between 

Name(s)

  and 

Name(s)

  concerning the property at 

Address or legal description of the premises

 as seller(s) (party[ies] of the first part),

 as purchaser(s) (party[ies] of the second part),

is in default because of nonpayment of installments of principal and/or interest, and also because of

 unpaid taxes.
 unpaid insurance premiums.
 other: 

Explain any other material breach claimed as the basis for forfeiture

2. You have forfeited your rights under the land contract, and payment is demanded by 
 seller.
 
                                                       
 assignee of seller.
  who holds the land contract as        
 other: 
                                                             
 

Name

 is now past due in principal and interest under the land contract, plus the sum of:

3. The sum of $ 
 
                   
 
                   
 
                   
 

 $ 
 
 $ 
 
 $ 
 

 for taxes.
 for insurance.
 other: 
 

The dates upon which payments were due are 
 

 .

 .

 .

 .

4. The total amount due, or the material breach(es) of contract, must be cured or paid within 
 

 days* 
from the date of the service of notice upon you. (*15 days, unless the parties have by contract agreed to a longer time.)

 

time stated, the land contract will be forfeited, as provided in the contract, and you will be required to move out and give

5. If the total amount due is not paid in full within the time stated, or if the material breach(es) is/are not cured within the
 
  up the described property without further notice to you. IF YOU DO NOT MOVE OR PAY VOLUNTARILY, THE 
  CONTRACT HOLDER MAY TAKE YOU TO COURT TO EVICT YOU.

 

 

 

 

 
 
 
 

   

Date

 

Signature

STATE OF MICHIGANJUDICIAL DISTRICTFORFEITURE NOTICELand ContractCASE NO. and JUDGECourt addressCourt telephone no.Approved, SCAOForm DC 101, Rev. 3/23MCL 600.5728, MCL 600.5730Page 1 of 1(To be copied, if necessary, to attach to the Complaint)Forfeiture Notice, Land Contract 

(3/23) 

Case No. 
 

 I served 

 

 personally     

 by first-class mail     a copy of the forfeiture notice, on: 

Name

Date and time of service

CERTIFICATE OF SERVICE

Place or address of service

 

                     

Attachments (if any)

Date and time
 

                     
                   

                     

 Name

 
I, 

of 

   

a. 

 

 

 

                     

                     

 I attempted to serve a copy of the forfeiture notice, together with the attachments listed below. I was unable to   
  complete service by one of the above methods. Service was made by publication (see proof of publication below).

 

I declare under the penalties of perjury that this certificate of service has been examined by me and that its contents are 
true to the best of my information, knowledge, and belief.
 

                     

 

 

  
Signature

 

 

  
Name (type or print)

I acknowledge that I have received service of a copy of the forfeiture notice, together with 

ACKNOWLEDGMENT OF SERVICE

 

 

 

 

 

Signature

Name (type or print)

PROOF OF PUBLICATION
 
 
 , am the     

 

 

 publisher     

 agent of the publisher

 , a qualified newspaper.  Attached is a copy of the 

notice of forfeiture of land contract taken from the newspaper. The dates of publication were:

 , b. 
 

 , and c. 
 

Signature

Name (type or print)

Subscribed and sworn to before me on 
 

                     

Date

 

 

 

 

 

 

 

 

My commission expires on 
 
Notary public, State of Michigan, County of 

                     

 

 

Deputy clerk/Notary public signature

 . 

Name (type or print)
 

 

 . 

 Acting in the County of 

 

 This notarial act was performed using an electronic notarization system or a remote electronic notarization platform.

 .

 

 .

 . 
 

 .

MCL 554.301, MCL 554.302, MCL 600.5730