Free mc273.pmd - Michigan

Approved, SCAO

Original - Court 1st copy - Prisoner 2nd copy - Department of Corrections 3rd copy - Return to court

STATE OF MICHIGAN JUDICIAL DISTRICT JUDICIAL CIRCUIT COUNTY PROBATE
Court address

CASE NO. PERSONAL SERVICE ON PRISONER AND AFFIDAVIT
Court telephone no.

Plaintiff(s)

Defendant(s)

v

Probate

Juvenile

In the matter of REQUEST

To the Warden/Administrator of You are requested to serve together with on

Name of correctional institution

Title or description of papers

List of attachments

on or before
Name of prisoner and prisoner identification number (if known)

.

Upon service, you must either complete the affidavit of service below or have the prisoner complete the acknowledgment of service below. If you are unable to complete service for some reason, you must return the original papers and all copies to the court clerk.

Date

Court clerk

AFFIDAVIT OF SERVICE
NOTE: This affidavit is prepared only when the prisoner does not acknowledge service.

I state that I am a legally competent adult who is not a party or an officer of a corporate party, and that I personally served the papers described above and attachments, if any, on on
Day, date, and time Name of prisoner and prisoner identification number (if known)

.
Signature Name (type or print)

Subscribed and sworn to before me on My commission expires:

Date

,

County and state Deputy court clerk/Notary public

.

Signature:

Notary public, State of Michigan, County of ACKNOWLEDGMENT OF SERVICE I acknowledge that I have received the papers described above on
Day, date, time

Prisoner signature MC 273 (3/09)

PERSONAL SERVICE ON PRISONER AND AFFIDAVIT

MCR 2.105