Free cia05.pmd - Michigan

Approved, SCAO

Original - Court 1st copy - Defendant 2nd copy - Prosecutor 3rd copy - Defendant (order)

STATE OF MICHIGAN JUDICIAL DISTRICT
Court address

CLAIM OF APPEAL OF RIGHT/ REQUEST TO WITHDRAW ADMISSION AND ORDER, Civil Infraction

CASE NO.

Court telephone no.

Plaintiff

Defendant's name and address

The of

State

Township

City

Village

v

Statute

Ordinance

Infraction:

Infraction date:

SECURITY FOR APPEAL/REQUEST TO WITHDRAW ADMISSION This is the plaintiff's appeal; no security is required. Bond is set at $ Fine and costs of $ . Bond was posted were paid on
Date Date

. .

CLAIM OF APPEAL OF RIGHT Plaintiff Defendant claims an appeal from the judgment entered on
Date

in this court, by the

traffic bureau.

magistrate.

district judge.

Date

Applicant signature Address City, state, zip

REQUEST TO WITHDRAW ADMISSION Defendant requests to withdraw the admission entered on
Date

in this court, by the

traffic bureau.

magistrate.

district judge.

Date

Defendant signature Address City,state, zip

ORDER REGARDING REQUEST TO WITHDRAW ADMISSION IT IS ORDERED the defendant's request to withdraw is
Date CIA 05 (4/08)

granted.
Judge/Magistrate

denied.

MCR 4.101(G), (H)(3)

CLAIM OF APPEAL OF RIGHT/REQUEST TO WITHDRAW ADMISSION AND ORDER, Civil Infraction