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STATE OF MICHIGAN JUDICIAL DISTRICT JUDICIAL CIRCUIT
Court address

CASE NO. ORDER AND RECEIPT FOR DRIVER'S LICENSE HELD AS SECURITY
Court telephone no.

The State of Michigan THE PEOPLE OF v

Defendant's name, address, and telephone no.

SID DLN

DOB License expiration

Date of hearing:
Date

Judge:
Bar no.

IT IS ORDERED: 1. The defendant's driver's license, described above and pictured below, shall be surrendered to this court in place of other security or in addition to personal recognizance, to guarantee the defendant's appearance for trial/sentencing, and shall be held until the date of trial/sentencing. trial sentencing on
Date

2. The defendant is required to appear in court for on that date.

, and this receipt expires

3. No court date has yet been set. However, this receipt expires on Date appear at court on this date in order to keep driving privileges.

, and the defendant must

4. The driving privileges the defendant possesses under his/her driver's license will continue until this receipt expires. The defendant may not drive after the expiration date unless otherwise ordered by this court. This receipt does not exceed the expiration date of the defendant's driver's license.

(SEAL)
Date

Judge

ATTACH LICENSE HERE TO PHOTOCOPY (Copy the restricted license onto the back of this form.)

MC 224 (3/08)

ORDER AND RECEIPT FOR DRIVER'S LICENSE HELD AS SECURITY

MCL 257.311a