Free cc79.pmd - Michigan

Approved, SCAO

Original - Court 1st copy - Appellant/Petitioner 2nd copy - Appellee/Respondent 3rd copy - Return

STATE OF MICHIGAN JUDICIAL CIRCUIT COUNTY
Court address

CLAIM OF APPEAL ON DENIAL OF APPLICATION FOR CONCEALED WEAPON LICENSE

CASE NO.

Court telephone no.

Appellant's/Petitioner's name, address, and telephone no.

Appellee's/Respondent's name, address, and telephone no.

v

Appellant's/Petitioner's attorney, bar no., address, and telephone no.

County clerk's name, address, and telephone no.

Before completing this form, see the other side for instructions. 1.
Name

, claims an appeal of a denial of an application for a concealed weapon license on
Date

in

County, Michigan.

2. A copy of the notice of the denial of the application for the concealed weapon permit is attached. The application was denied based upon the grounds specified in MCL 28.425b(7)(n).
Date Appellant/Attorney signature

NOTICE OF HEARING Take notice that on
Location Date

at

Time

at

the above location, courtroom

or ,

a hearing before Hon.

Bar no.

will be held on the above claim of appeal.

PROOF OF SERVICE I certify that I served a copy of this claim of appeal and notice of hearing on the individuals of this county as follows: personal service. first-class mail. personal service. first-class mail. personal service. first-class mail.

Name of county clerk

on
Date

by

on
Name of county prosecutor or alternative Date

by

Name of sheriff

on

Date

by

Date CC 79 (3/08)

Signature

CLAIM OF APPEAL ON DENIAL OF APPLICATION FOR CONCEALED WEAPON LICENSE

MCL 28.425d

INSTRUCTIONS 1. Complete the front of this form up to the Notice of Hearing portion. 2. Present the Claim of Appeal and all copies to the county clerk (clerk of the circuit court) in the county where the concealed weapon license application was denied. 3. Pay the filing fee to the county clerk. 4. Ask the county clerk how to obtain a day and time for the notice of hearing on the Claim of Appeal. 5. Mail or deliver a copy of this Claim of Appeal, with the hearing date, time, and location filled in, to the county clerk, the county prosecutor or his/her alternate who is serving on the concealed weapon licensing board, and the sheriff. 6. After you have mailed or delivered copies, complete the proof of service on the "return" copy and file it with the county clerk. 7. Appear at the hearing.