Free (cc386.pdf) - Michigan

Approved, SCAO

Original - Court file Copies as needed

STATE OF MICHIGAN JUDICIAL CIRCUIT COUNTY
Court address

PROOF OF SERVICE/ORAL NOTICE REGARDING PERSONAL PROTECTION ORDER

CASE NO.

Court telephone no.

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

v

Respondent's name, address, and telephone no.

AFFIDAVIT OF SERVICE I certify that on this date I personally served at
Address or location of service Date Respondent name

with a copy of the personal protection order issued on Circuit Court.
Officer signature Name (type or print)

by the

Law enforcement agency ID no. Address City, state, zip Telephone no.

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 PROOF OF ORAL NOTICE I certify that on this date I orally notified
Respondent name Date

of by the

the existence of a personal protection order issued on

Circuit Court. I also certify that the respondent was advised of the following: · the specific conduct enjoined. · the penalties for violating the order. · where the respondent could obtain a copy of the personal protection order.

Date

Officer signature Name (type or print) Law enforcement agency Address City, state, zip Telephone no. MCL 600.2950(22), MCL 600.2950a(19), MCR 3.706(E) ID no.

CC 386 (6/04)

PROOF OF SERVICE/ORAL NOTICE REGARDING PERSONAL PROTECTION ORDER