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JIS CODE: SUM

STATE OF MICHIGAN
JUDICIAL CIRCUIT - FAMILY DIVISION

COUNTY
Court address

SUMMONS: ORDER TO APPEAR (CHILD PROTECTIVE PROCEEDINGS)

CASE NO. PETITION NO.

Court telephone no.

1. In the matter of
name(s), alias(es), DOB

2. TO:

3. YOU ARE ORDERED to appear in person before the court for a hearing on the allegations in the attached petition. The appearance of the child(ren) named above is is not necessary. 4. The date, time, and place of the hearing are:

5. The purpose of the hearing is to decide, at a trial, whether one or more of the statutory grounds alleged in the petition are true. to rule on a request that your parental rights over the child(ren) be terminated. to decide if you are the father of the child(ren) named above. other: 6. RIGHT TO ATTORNEY: As a respondent you have the right to be represented by an attorney. If you want an attorney, you should hire one immediately so the attorney will be ready on the hearing date. If you want an attorney but are not financially able to hire an attorney, you should contact the court immediately about a court-appointed attorney. 7. RIGHT TO TRIAL BY JURY: If you want a jury to decide the facts at the trial, you must file a written request with the court within 14 days after the court gives notice of the right to jury trial or 14 days after an appearance by an attorney, whichever is later, but no later than 21 days before trial. There is no right to a jury at a termination of parental rights hearing. 8. RIGHT TO TRIAL BY JUDGE: Either a judge or a referee may decide the facts at a trial without a jury. If you want a judge to decide the facts at the trial, you must file a written request with the court within 14 days after the court gives notice of the right to a judge or 14 days after an appearance by an attorney, whichever is later, but no later than 21 days before trial. If you require special accommodations to use the court because of a disability or if you require a foreign language interpreter to help you to fully participate in court proceedings, please contact the court immediately to make arrangements. WARNING: You are notified that this hearing may result in a temporary or permanent loss of your rights to the child(ren). FAILURE TO APPEAR may subject you to the penalty for contempt of court, and a bench warrant may be issued for your arrest.
Date Judge Bar no. MCL 712A.13, MCR 3.911, MCR 3.912, MCR 3.915, MCR 3.920, MCR 3.928

JC 21 (11/05)

SUMMONS: ORDER TO APPEAR (CHILD PROTECTIVE PROCEEDINGS)

SUMMONS Case No. Petition No. PROOF OF SERVICE TO PROCESS SERVER: You are to serve the summons and petition in accordance with MCR 3.920(B)(5) and the instructions of the court. You must make and file your return with the court clerk. If you are unable to complete service you must complete item 3 and return this original and all copies to the court clerk. Always mark either the box for "Officer Certificate" or "Affidavit of Process Server." CERTIFICATE / AFFIDAVIT OF SERVICE / NON-SERVICE OR OFFICER CERTIFICATE I certify that I am a sheriff, deputy sheriff, bailiff, appointed court officer, or attorney for a party [MCR 2.104(A)(2)], and that: (notarization not required) AFFIDAVIT OF PROCESS SERVER Being first duly sworn, I state that I am a legally competent adult who is not a party or an officer of a corporate party, and that: (notarization required)

1. I served personally a copy of the summons and petition, 2. I served by registered or certified mail (copy of return receipt attached) a copy of the summons and petition, together with
List all documents served with the summons and petition

on:
Name Complete address(es) of service Day, date, time

3. I have personally attempted to serve the summons and petition, together with any attachments, on the following individual(s) and have been unable to complete service.
Name Complete address(es) of service Day, date, time

Service fee

Miles traveled

Mileage fee

Total fee

Signature Title

$

$

$

Subscribed and sworn to before me on My commission expires:
Date

Date

, Signature:
Deputy clerk/Notary public

County, Michigan.

Notary public, State of Michigan, County of ACKNOWLEDGMENT OF SERVICE I acknowledge that I have received service of the summons and petition, together with on
Signature Day, date, time Attachments

on behalf of

.