Civil Infraction: 
  
The 
	
	
	
  v 
 

  State 
	 ┌	 	
  
 

	

  Twp. 

  City 

  Village  of: 
  

Defendant’s name, address, and telephone no.

 

Infraction date: 
 
  

 

  Statute 

  Ordinance

┐
  

 

Vehicle Plate No.:

	

	

	

	 └	 	

	
If you fail to pay the amount due within 14 days of the date of this notice,*
1.  the Secretary of State may suspend your driving privileges for some driving offenses.
2.  a bench warrant may be issued for your arrest.
3.  the cost to compel appearance may be added to the amount of your judgment.

	┘

Amount due: $ 

*Date of Notice: 

 

 

NOTICE OF FAILURE TO
COMPLY WITH JUDGMENT

Note:	Fines,	costs,	and	other	financial	
obligations imposed by the court must be 
paid at the time of assessment, except 
when the court allows otherwise, for good 
cause shown.

If you are not able to pay due to financial 
hardship, contact the court immediately 
to request a payment alternative.

Approved, SCAO
Form CIA 03, Rev. 8/21
MCL 257.321a(1), MCR 1.110
Page 1 of 1

Distribute form to: 
Court  
Defendant 

STATE OF MICHIGANJUDICIAL DISTRICT14-DAY NOTICECivil InfractionCASE NO. and JUDGECourt address                 Court telephone no.

CIA 03, 14-day Notice, Civil Infraction

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About This Form:

• Sourced from www.courts.michigan.gov/civil-infraction (2023-03)
• Page(s): 1
• Fields(s): 18
• Average fields per page: 18
• Reading Level: Grade 9
• LIST Grouping(s): CO-00-00-00-00, CO-07-00-00-00.

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