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Approved, SCAO

Original - Court

Copy - Defendant

STATE OF MICHIGAN JUDICIAL DISTRICT

DEFAULT JUDGMENT Civil Infraction

Court Telephone No.

The State Twp. City Village of: v Defendant (name and address printed on other side) DEFAULT ENTRY I certify that the 1. defendant has not made a scheduled appearance or answered a citation within time allowed by statute. 2. defendant is not in the military service, or is in the military service but received notice and adequate time and opportunity to appear and defend. 3. default is entered against the defendant. DEFAULT JUDGMENT is entered in the amount stated on the other side. Return this notice with a certified check or money order in the amount of the judgment stated on the other side of this form. Fines, costs, and other financial obligations imposed by the court must be paid at the time of assessment. If you fail to pay, the court will notify the Secretary of State to take action against your driving privileges. Fines, costs, and fees not paid within 56 days of the appearance date are subject to a 20% late penalty on the amount owed. CERTIFICATE OF SERVICE I certify that on this date I served a copy of this judgment on the defendant by first-class mail addressed to his/her last-known address as defined in MCR 2.107(C)(3). Date of Default/Judgment*
Date of entry and mailing Clerk/Deputy clerk/Magistrate NOTICE: You may have the right to set aside a default by requesting a hearing within 14 days of the mailing date. You must post a bond equal to the total fine and costs noted when requesting a hearing to set aside a default. CIA 07-JIS (3/08)

DEFAULT JUDGMENT, Civil Infraction

MCR 1.110, MCR 4.101(B)

DEFAULT JUDGMENT Civil Infraction
Case Number Infraction Date Civil Infraction Vehicle Plate No. Appearance Date Default/Judgment Date*

AMOUNT OF JUDGMENT

Fine Costs State Costs Total Bond Forfeited Balance Due

$ $ $ $ $ $ $

TO