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STATE OF MICHIGAN JUDICIAL CIRCUIT COUNTY
Court address

MOTION TO MODIFY, EXTEND, OR TERMINATE PERSONAL PROTECTION ORDER

A

CASE NO.

Court telephone no.

B

Petitioner name Address and telephone no. where court can reach petitioner

Age

Respondent name, address, and telephone no.

Age

v

MOTION

C D

1. On 2.

Date

a personal protection order was entered by this court. the order because:

a. I am the respondent. I ask the court to conduct a hearing to modify terminate b. I am the petitioner. I ask the court to conduct a hearing to modify the order because: c. I am the petitioner. I ask the court to extend terminate the order because:
Explain why you want the order modified, extended, or terminated.

E

3. I have a next friend motioning for me. I certify that the next friend is not disqualified by statute and is an adult.

F

Date Complete this Notice of Hearing only if you checked box 2.a. or 2.b. above.

Signature of moving party

NOTICE OF HEARING

G

You are notified that a hearing has been scheduled to modify, extend, or terminate the personal protection order issued in this case. Judge: Date: Time: Location: If you require special accommodations to use the court because of disabilities, please contact the court immediately to make arrangements. The court can modify, extend, or terminate the order even if you do not attend the hearing. It is important for you to attend.

H

Date

Signature of moving party

FOR COURT USE ONLY The motion to terminate by the petitioner is granted without hearing. A Removal of Entry from LEIN (Form MC 239) shall be issued.
Date Judge MCL 600.2950, MCL 600.2950a, MCR 3.707 CC 379 (3/09)

MOTION TO MODIFY, EXTEND, OR TERMINATE PERSONAL PROTECTION ORDER

PROOF OF SERVICE

Motion to Modify/Extend/Terminate Personal Protection Order Case No.

TO PROCESS SERVER: You must serve the copies of the motion to modify, extend, or terminate personal protection order and file proof of service with the court clerk. If you are unable to complete service, you must return this original and all copies to the court clerk. CERTIFICATE / AFFIDAVIT OF SERVICE / NONSERVICE 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)

I served a copy of the motion to modify, extend, or terminate personal protection order by: personal service registered mail, delivery restricted to the nonmoving party (return receipt attached) on:
Nonmoving party name Complete address of service Day, date, time

I have personally attempted to serve a copy of the motion to modify, extend, or terminate personal protection order on the following party and have been unable to complete service.
Nonmoving party name Complete address of service

I declare that the statements above are true to the best of my information, knowledge, and belief.
Service fee Miles traveled Fee Signature Name (type or print) Incorrect address fee Miles traveled Fee TOTAL FEE

$ $

$ $ $

Title

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

Date

, Signature:
Deputy court clerk/Notary public

County, Michigan.

Notary public, State of Michigan, County of

ACKNOWLEDGMENT OF SERVICE I acknowledge that I have received a copy of the motion to modify, extend, or terminate personal protection order on .
Day, date, time Signature of nonmoving party

MCR 2.105(A)(2)

Form CC 379 MOTION TO MODIFY, EXTEND, OR TERMINATE PERSONAL PROTECTION ORDER
Use this form if you want the court to modify, extend, or terminate the personal protection order.

INSTRUCTIONS FOR COMPLETING "MOTION TO MODIFY, EXTEND, OR TERMINATE PERSONAL PROTECTION ORDER" Please print neatly. Press firmly because you are printing on five copies. By filling in this form, you are asking the court to modify, extend, or terminate a personal protection order. Items A through E must be completed before your motion can be filed with the court. Please read the instruction for each item. Then fill in the correct information for that item on the form. A B Fill in the "Case No." the same way it appears on form CC 376 or CC 380. Fill in the "petitioner" and "respondent" and addresses the same way they appear on form CC 376 or CC 380. including the ages of the "petitioner" and "respondent" if either of you are under the age of 18. Write in the same date that form CC 376 or CC 380 was signed by the judge. That date is in the lower left hand corner of form CC 376 or CC 380. If you are the person the protection order is against, check item 2.a. Also check either the box "modify" if you want the court to change something in the order or check the box "terminate" if you want the court to terminate the entire order. Then explain why you want the order changed or terminated. If you are the person who is protected by the order, you can check either item 2.b. or item 2.c. Check item 2.b. if you want the court to change something in the order. Check item 2.c. if you want the court to extend the expiration date of the order or terminate the entire order. Then explain why you want the order changed, extended, or terminated. To extend the expiration date of the order, you must file this motion no later than 3 days before the order expires. E If you are under 18 years old, you may need an adult (called a "next friend") to petition for you. Check this box if you have a next friend helping you file this form. Write in today's date and sign the form. If you checked box 2.a. or box 2.b. in D you must get a hearing date. Ask the clerk to schedule a hearing. The clerk will give you the information you need to fill out this part of the form. If you checked box 2.c. and the judge terminates the order without a hearing, skip the instructions below in H . If you checked box 2.c. and the judge will not terminate the order without a hearing, follow the instructions below in H . Write in today's date and sign the form. Hand the form to the county clerk. The clerk will keep two copies and return the blue, pink, and yellow copies to you.

C

D

F G

H

You must serve the other party with a copy of this form. If there is a hearing scheduled, you must serve this form at least 7 days before the hearing date unless the respondent is a law enforcement officer. If the respondent is a law enforcement officer, you must serve this form at least 5 days before the hearing date. For details about serving the form, read page 7 of the booklet "Instructions for Personal Protection Orders." If a hearing was scheduled, make sure you attend the hearing. Take a blank copy of form CC 376 or CC 380 with you to the hearing. If a hearing was not scheduled, the court will notify the law enforcement agency to make changes to LEIN as stated in the order. · · For details about the hearing, read page 8 of the booklet "Instructions for Personal Protection Orders." If you asked for a modified order and it is granted by the judge, you will need to fill out form CC 376 or CC 380, get it signed, and serve it on the other party. For details on how to do this, read pages 5 and 6 of the booklet "Instructions for Personal Protection Orders."